不同肠内营养制剂对老年糖尿病机械通气患者的影响研究

430070。8624046。21529、、、、2h、BNT－proBNP。15、、、NT－proBNPP＞0．052hP＜0．05、、P＜0．052h、NT－proBNPP＞0．052P＞0．05。292、、、、2h2P＞0．05P＜0．05NT－proBNPP＜0．05。、、。NT－proBNP。doi10．3969/j．issn．1008－8849．2016．07．010Ｒ587．1A1008－8849201607－0719－04Clinicalstudyofenteralnutritioninelderlypatientswithtype2diabetesmellitustreatedwithMechanicalVentilationLIJuanLIShupingJIANGHuiWuhanGeneralHospitalofGuangzhouMilitaryCommandWuhan430070HubeiChinaAbstractObjectiveItistoexploreasuitablewayofenteralnutritiontoelderlypatientswithtype2diabetesmellitustreatedwithmechanicalventilation．Methods86elderlypatientswithtype2diabetesmellitusandusingmechanicalventilationweredividedinto2groupsaccordingtotheirreceivingdifferentnutritionagentsENprescriptionforDMgrouptherapygroupandENprescriptionwithstandardenergygroupcontrolgroup．Changesofserumalbuminprealbuminlymphocytecountinthe2groupswereobserved．WithcontinuoussugarmonitoringsystemCGMSandcontinuoussubcutaneousinsulininfusionCSIIchangesoffastingbloodglucoseFBGandpostprandialbloodglucosePBGwererecordedandthedosisofinsulinwereadjusted．ＲesultsTwoweekslaterserumalbuminprealbuminlymphocytecountincontrolgroupwerehigh-erthanthoseoftwoweeksagoP＜0．05buttherewerenoimprovedsignificantlyintherapygroupFBGandPBGintherapygroupwerelowerthanthoseoftwoweeksagoP＜0．05whiletherewerenosamechangesinthecontrolgroup．FourweekslaterallindicatorsinthebothgroupswereimprovedsignificantlyThedosisofinsulinintherapygroupwerelowerthanthoseof4weeksagoP＜0．05whilethedosisofinsulinincontrolgroupwerehigherthanthoseof4weeksagobuttherewasnosignificantdifferenceP＞0．05．TheindicatorofheartfailureNT－proBNPintherapygroupwashigherthanthatofbeforetreatmentP＜0．05．ConclusionWithENprescriptionforDMBGoftheelderlypatientswithtype2diabetesmellitusandusingmechanicalventilationquicklyreachesthetargetvaluewiththeENprescriptionwithstandardenergygrouppatients’nutritionindicatorsrapidlyrecovertonormallevels．NT－proBNPneedstobecloselymonitoredinpatientswithheartorrenalfailure．Keywordsmechanicalventilationdiabetesmellitusenteralnutritionelderlypatient·917·ModernJournalofIntegratedTraditionalChineseandWesternMedicine2016Mar257。[e-mail]13BJZ14。、。。。20136—20141286。11.186、。24039185．8±5.6APACHEⅡ34．39±4．23382。4645186．8±8．6APACHEⅡ32．40±6．644231。2、、APACHEⅡ、P＞0．05。1.21000mL84g、32g、32g、21.7g、15g44．6%70%30%26%。680%1．5mg90μg0．75kcal/mL1kcal=4．2kJ。1000mL184．5g、60g、58．35g、35．55g、22．5g49．1%21%1．5kcal/mL。Harris－Bene-dictBEE。BEE=66.47+13．75×kg+5．0×cm－6．76×BEE=65．5+9．6×kg+1．7×cm－4.7×。BEE×1．161．19+10%BEE。2。124h40%24h30%。1.32。、。40．3±3．3IU/d42．5±3．1IU/d2P＞0．05。1.421d1529、、、、2h、BNT－proBNP。1.5SPSS17．0珋x±st。P＜0．05。22.122P＞0．05。15、、P＞0．052hP＜0．05、、P＜0．052hP＞0．052P＞0.05。292、、、、2h2P＞0．05P＜0．05P＞0.05。1。2.22NT－proBNP2NT－proBNPP＞0．05152NT－proBNPP＞0．0529NT－proBNPP＜0．05NT－proBNPP＞0．05。2。2.322/、2、、。3·027·ModernJournalofIntegratedTraditionalChineseandWesternMedicine2016Mar25712珋x±sn=401529n=401529/g/L36．2±3．636．2±4．636．3±2．9①33．8±2．635．2±3．6①36．8±3．2①/g/L0．21±0．040．21±0．060．21±0．03①0．19±0．560．21±0．58①0．23±0．04①/109L－11．66±0．671．62±0．531．88±0．54①1．46±0．751．69±0．62①1．81±0．56①/mmol/L7．92±1．567．37±1．15①7．76±1．05①8．10±2．047．92±1．537．60±0．86①2h/mmol/L10．26±1．819．54±1．32①9．32±1．07①10．18±1．8810．23±2．0210．28±1．38①/IU/d40．3±3．340．0±3．339．2±3．5①②42．5±3．143．1±3．842．6±3．6①P＜0．05②P＜0．05。22NT－proBNP珋x±spg/mLn1529404697±45184673±47946631±8197①②466110±67365220±50895824±5656①P＜0．05②P＜0．05。。、1。2。、、、。。3。345。6。。7。、、。8。。。20089。680%。、、44．6%∶17．1%∶38．3%349%∶16%∶35%。750kcal84．0g15g92．25g11．25g。70%、30%。10。、8。2、4、。、、。、。NT－proBNP11。4NT－proBNP/、Ⅲ～ⅣNT－proBNP。、776·127·ModernJournalofIntegratedTraditionalChineseandWesternMedicine2016Mar25717。、。。。1．J．201386496－5002．－J．2011317150－1513．J．200833222692－26964．J．2006459786－7875．M．2．20024106．－J．20153136－1387．J．2014111190－918．GATA－1GATA－2J．20042552819．J．2002275371－37310．J．200619117－1911．J．200616175－7612．J．2013282164－17113．J．2003132140－14314．J．200515448－5115．J．200976664－66516．56J．2008103369－37017．J．2013305443－445櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵櫵2015－03－17721、、。NT－proBNP。1．J．20021853－42．J．2004116338－3403SehrezenmeirJ．Ｒationalforspecializednutritionsupportforhyper-glycemiepatientsJ．ClinNutr199817Suppl226－344MarangoniFPoliA．TheglycemicindexofbreadandbiscuitsismarkedlyreducedbytheadditionofaproprietaryfibermixturetotheingredientsJ．NutrMetabCardiovascDis2008189602－6055．J．2010174209－2116．J．200193181－1837ParilloMＲivelleseAACiardulloAVetal．Ahighmono-unsatu-ratedfat/low-carbohydratedietimprovesperipheralinsulinsensitivi-tyinnon-insulin-dependentdiabeticpatientsJ．Metabolism199241151373－13788．J．2005125276－2819AmericanDiabetesAssociationBantleJPWylie-ＲosettJetal．NutritionrecommendationsandinterventionsfordiabetesapositionstatementoftheAmericanDiabetesAssociationJ．DiabetesCare200831Suppl1S61－7810HooverHC．NutritionalbenefitsofimmediatepostoperativejejunalfeedingofanelementaldietJ．AMSurg198013918－1111．J．2013815300－3023162015－10－15·677·ModernJournalofIntegratedTraditionalChineseandWesternMedicine2016Mar257