【摘要】 目的探讨合并糖尿病的胃肠道肿瘤患者在术后早期肠内营养(EEN)过程中控制血糖的安全、有效方法。方法37例胃肠道肿瘤合并糖尿病患者术后24h开始应用糖尿病患者EN专用制剂益力佳SR,并采取应激期持续静脉滴注胰岛素和稳定期皮下注射中效胰岛素的方法控制血糖,同时在术后EN前、EN第5d、第8d监测各项营养、生化及免疫指标。结果患者均可耐受术后EEN,无一例发生严重并发症。EN后营养评定指标血清白蛋白、前清蛋白及转铁蛋白水平显著增高(P<0.05,P<0.01);体重、血红蛋白、丙氨酸氨基转移酶及总胆红素无明显改变(P>0.05),免疫指标IgG、IgA及IgM水平亦有明显升高(P<0.01);81.1%(30/37)的患者血糖稳定控制在(7.8±1.1)mmol/L范围内。结论对于胃肠道肿瘤合并糖尿病患者,术后早期应用糖尿病患者专用EN制剂是营养支持的有效手段。静脉滴注和皮下注射胰岛素相结合控制血糖是一种安全、可靠的降血糖措施。更多还原

【Abstract】 Objective To investigate the safety and efficiency of a blood glucose control method in diabetic patients with gastrointestinal neoplasm who were subjected to postoperative early enteral nutrition(EEN).Methods Thirty-seven diabetic patients with gastrointestinal neoplasm received enteral nutriment——Glucerna SR through nasojejunal tubes 24 hours after operation.The blood glucose level was safely controlled through injecting insulin intravenously and subcutaneously.Meanwhile,any change of blood and urine glucose level was monitored and the indexes representing the levels of nutrition,biochemistry and immunity were measured before the implementation of EN,5 d and 8 d of EN after operation,respectively.Results All the patients were able to bear EEN and there was no severe complications occurred.Significant increase of serum levels of albumin,prealbumin and transferrin were observed after EEN support(P<0.05),as well as the serum levels of IgG,IgA and IgM(P<0.01).However,body weight,HGB and the serum levels of ALT and TBIL showed no significant changes(P>0.05).There were 81.1%(30/37)of patients whose blood glucose levels were controlled steadily within the range of(7.8±1.1)mmol/L.Conclusion Injecting insulin intravenously and subcutaneously after operation may be a safe and effective method to control blood glucose level.And the postoperative implementation of EEN can be considered as the first choice of nutrition support for diabetic patients with gastrointestinal neoplasm.更多还原