[1]符小婧,何书杏,苏连红,等.糖尿病专用肠内营养制剂对胃癌术后病人应激性血糖波动和胰 岛素抵抗的影响[J].肠外与肠内营养杂志,2021,(04):225-229.[doi:10.16151/j.1007-810x.2021.04.008]
　FU Xiao-jing,HE Shu-xing,SU Lian-hong,et al.Influence of diabetes-specific enteral nutrition on stress-induced blood glucose fluctuations and insulin resistance in postoperative patients with gastric cancer[J].PARENTERAL & ENTERAL NUTRITION,2021,(04):225-229.[doi:10.16151/j.1007-810x.2021.04.008]
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糖尿病专用肠内营养制剂对胃癌术后病人应激性血糖波动和胰 岛素抵抗的影响
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《肠外与肠内营养》杂志[ISSN:1007-810X/CN:32-1477/R]

卷:
期数:
2021年04期
页码:
225-229
栏目:
论著
出版日期:
2021-07-10

文章信息/Info

Title:
Influence of diabetes-specific enteral nutrition on stress-induced blood glucose fluctuations and insulin resistance in postoperative patients with gastric cancer
作者:
符小婧; 何书杏; 苏连红; 王华圆
海南省中医院外一科，海南海口 570203
Author(s):
FU Xiao-jing;  HE Shu-xing;  SU Lian-hong;  WANG Hua-yuan
Department of General Surgery，Hainan hospital of traditional Chinese medicine, Haikou 570203, Hainan, China
关键词:
胃癌 ; 肠内营养 ; 应激性血糖波动 ; 胰岛素抵抗
Keywords:
Gastric cancer;  Enteral nutrition;  Stress blood glucose fluctuation;  Insulin resistance
分类号:
R459.3，R587.1
DOI:
10.16151/j.1007-810x.2021.04.008
文献标志码:
A
摘要:
目的：探讨糖尿病专用肠内营养制剂对胃癌术后病人应激性血糖波动和胰岛素抵抗（IR）的影响。方法：选取 2018年 3月至 2020年 5月在海南省中医院外一科行胃癌根治术的Ⅰ ~ Ⅲ期胃癌病人 142例，按 1:1:1随机分，最终纳入符合标准的病人为肠内营养 A组 49例，肠内营养 B组 48例和肠外营养组 45例，肠内营养 A组术后给予糖尿病专用肠内营养混悬液，肠内营养 B组给予普通肠内营养混悬液，肠外营养组给予肠外营养支持。比较三组病人术后 1、3、7天 IR状态，术后 6 d内血糖波动水平，术前 1 d和术后 7 d血清总蛋白、白蛋白、前蛋白等营养指标，术后切口愈合和感染情况，以及住院时间和住院费用。IR状态应用胰岛素抵抗指数（HOMA-IR）进行评价，血糖波动水平采用平均血糖波动幅度（MAGE）和血糖不稳定指数（GLI）进行评价。 结果：肠外营养组病人术后各营养指标均低于肠内营养组，HOMA-IR指数，IR发生率、MAGE、GLI以及住院时间、住院费用均高于肠内营养组（P <0.05），术后 3、7 d肠内营养 A组 HOMA-IR指数、IR发生率均低于肠内营养 B组，差异有统计学意义（P < 0.05），术后6天内肠内营养 A组 MAGE和 GLI均低于肠内营养 B组，差异有统计学意义（P < 0.01），术后 7 d两肠内营养组病人营养指标均较术前无明显变化，且组间比较也无统计学差异（P > 0.05），肠内营养 A 组术后切口甲级愈合率为85.7%，高于肠内营养 B组的 64.6%，肠内营养 A组术后切口感染发生率为 0%，低于肠内营养 B组的 8.3%，差异有统计学意义（P < 0.05）。 结论：糖尿病专用肠内营养制剂有助于改善胃癌术后病人应激性血糖波动和 IR状态，降低手术切口愈合不良和感染的发生，促进术后快速康复。
Abstract:
Objective: To investigate the influence of diabetes-specific enteral nutrition on stress-induced blood glucose fluctuations and insulin resistance (IR) in postoperative patients with gastric cancer. Methods: One hundred and forty-two patients with stage Ⅰ-Ⅲ gastric cancer who treated by surgically during March 2018 to May 2020 were randomly divided into three groups: enteral nutrition group A (49 cases), enteral nutrition group B (48 cases) and parenteral nutrition group (45 cases). The patients in the enteral nutrition group A were served with diabetes-specific enteral nutrition suspension, the patients in the enteral nutrition group B were served with normal enteral nutrition suspension, and the patients in the parenteral nutrition group were administrated with total parenteral nutrition. The IR status at the postoperative 1, 3 and 7 days and the blood glucose variability level within 6 days after operation among the three groups were compared. The nutritional indicators (serum total protein, albumin, prealbumin) at the preoperative 1 day and the postoperative 7 day, and the incidence of postoperative incision healing and infection were compared among the three groups. The IR status was evaluated by insulin resistance index (HOMA-IR), and the blood glucose variability level was evaluated by mean amplitude of glycaemic excursions (MAGE) and glycemic lability index (GLI). Results: Compared with the enteral nutrition group, patients in the parenteral nutrition group had significant lower levels of nutritional indicators, higher significant levels of HOMA-IR, incidence of IR, MAGE, GLI, and hospital stays, hospitalization expenses (P < 0.05). The HOMA-IR, incidence of IR at the postoperative 3 and 7 days in the enteral nutrition group A were significantly lower than those in the enteral nutrition group B (P < 0.05). The MAGE and GLI within 6 days after operation of the patients in the enteral nutrition group A were significantly lower than those of the enteral nutrition group B (P < 0.01). Comparison with preoperative, there was no significant changes in the nutritional indicators in enteral nutrition groups at the postoperative 7 day, while there were no significant differences between the two groups too (P > 0.05). Compared with enteral nutrition group B, patients in enteral nutrition group A had significant higher levels of healing rate of grade A (85.7% vs 64.6%), and significant lower levels of incision infection rate (0% vs 8.3%) (P < 0.05). Conclusion: The diabetes-specific enteral nutrition can help to reduce stress-induced blood glucose fluctuations and insulin resistance in postoperative patients with gastric cancer, and decrease the incidence of poor incision healing and infection.

参考文献/References:


[1] 雷 强 . 胃癌根治术后应激性高血糖与肠道黏膜屏障功能的相关性考察 . 中国临床药理学与治疗学, 2017,22(4):471-476.
[2] Zong L, Li H, Li S. Effects of neoadjuvant chemotherapy combined with enteral nutrition on perioperative immunity,inflammation and intestinal flora in gastric cancer patients. J BUON, 2019, 24(3):1113-1119.
[3] 闫凯旋, 曹 铖, 杨 磊, 等 . 糖尿病专用型肠内营养混悬液对重型脑损伤病人营养指标以及免疫功能的影响 . 肠外与肠内营养,2018, 25(2):76-80.
[4] Wang J, Zhao J, Zhang Y, et al. Early enteral nutrition and total parenteral nutrition on the nutritional status and blood glucose in patients with gastric cancer complicated with diabetes mellitus after radical gastrectomy. Exp Ther Med, 2018, 16(1):321-327.
[5] 阙海峰, 徐宏涛, 潘爱秀, 等 . 加速康复外科在胃癌手术中的应用及对术后胰岛素抵抗的影响 . 浙江医学, 2018, 40(14):1580-1582,1588.
[6] Tewari N, Awad S, Du?ka F, et al. Postoperative inflammation and insulin resistance in relation to body composition, adiposity and carbohydrate treatment: A randomised controlled study. Clin Nutr, 2019, 38(1):204-212.
[7] 王欣雪, 赵元顺, 徐克雷 . 糖尿病专用肠内营养混悬液康全力对肝脏术后患者血糖的影响 . 中国医院药学杂志, 2017, 37(15):1502-1504.
[8] Shao Y, Heng W, Li S, et al. Tube Feeding with a DiabetesSpecific Enteral Formula Improves Glycemic Control in Severe Acute Ischemic Stroke Patients. JPEN J Parenter Enteral Nutr,2018, 42(5):926-932.
[9] 张 馨, 衡卫卫, 李姗姗, 等 . 新型糖尿病肠内营养制剂改善急性重症缺血性脑卒中病人的血糖和胰岛素抵抗状态 . 肠外与肠内营养, 2016, 23(6):342-345.
[10] Yoon JE, Sunwoo JS, Kim JS, et al. Poststroke glycemic variability increased recurrent cardiovascular events in diabetic patients. J Diabetes Complications, 2017,31(2):390-394.
[11] Doola R, Todd AS, Forbes JM, et al. Diabetes-Specific Formulae Versus Standard Formulae as Enteral Nutrition to Treat Hyperglycemia in Critically Ill Patients: Protocol for a Randomized Controlled Feasibility Trial. JMIR Res Protoc, 2018,7(4):e90.
[12] 张 静, 王 凯, 齐 咏 . 糖尿病专用肠内营养液对脓毒症机械通气患者应激性血糖波动及临床结局的影响 . 中华老年医学杂志,2018,37(10):1098-1101.
[13] Kim YI, Cho SJ, Lee JY, et al. Effect of Helicobacter pylori Eradication on Long-Term Survival after Distal Gastrectomy for Gastric Cancer. Cancer Res Treat, 2016, 48(3): 1020-1029.
[14] 王之伟, 陈 军, 任建安, 等 . 全国多中心腹部手术后手术部位感染的横断面研究 . 中华胃肠外科杂志, 2018,21(12):1366-1373.
[15] 刘彦合, 李 慧, 叶晓谊, 等 . 胃肠肿瘤患者术后切口感染影响因素分析及对策 . 中华医院感染学杂志, 2019, 29(2):249-253

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备注/Memo

备注/Memo:
作者简介 ：符小婧，主管护师，护理本科，主要从事胃癌术后管理。E-mail:fuxj7667@126.com
更新日期/Last Update: 1900-01-01