摘要[摘要]目的 探讨营养泵持续滴注营养液方法进行早期肠内营养（EEN）对危重症患者的应激性高血糖（SHG）状态和胰岛素抵抗（IR）的改善效果。方法 选取2018年6月1日～2019年6月30日我院收治的174例存在SHG的危重症患者作为研究对象，按照随机数字表法将其分为实验组（89例）和对照组（85例）。实验组患者采用持续营养泵滴注方法进行EEN，对照组患者采用间断鼻饲分次推注方法。比较两组患者营养治疗后第7天的血糖相关指标[4、8、12、16、20 h 血糖、血糖变异系数（BGcv）、高血糖发生率]、胰岛素抵抗指数（HOMA-IR）值、IR发生率、空腹胰岛素（FINS）、最大耐受热量、完全肠内营养比例、肠道耐受性、空腹血糖（FBG）及7 d 内累积使用胰岛素总量，并记录两组患者治疗前2 d 与治疗后第7天的血清清蛋白（ALB）水平。结果 实验组患者营养治疗后第7天4、8、12、16、20 h 血糖、BGcv、高血糖发生率均低于对照组，差异有统计学意义（P＜0.05）。实验组患者治疗后第7天的HOMA-IR值、IR发生率、FINS及7 d 内累积使用胰岛素总量均低于对照组，差异有统计学意义（P＜0.05）；实验组患者治疗后第7天最大耐受热量、完全肠内营养比例、肠道耐受性均高于对照组，差异有统计学意义（P＜0.05）；两组患者治疗后第7天的FBG水平比较，差异无统计学意义（P＞0.05）。两组患者治疗前2 d、治疗后第7天的ALB水平比较，差异无统计学意义（P＞0.05）。结论 与分次推注相比较，营养泵滴注能更好地改善危重症患者SHG 状态和营养支持治疗后的IR，且能配合血糖调控，降低高血糖发生率，为危重症患者提供足够的能量支持，提高患者胃肠耐受性，在实际工作中有推广意义。
Abstract：[Abstract]Objective To investigate the effect of continuous nutrition pump infusion for early enteral nutrition（EEN）on improving stress hyperglycemia（SHG）and insulin resistance（IR）in critically ill patients.Methods A total of 174 critically ill patients with SHG treated in our hospital from June 1，2018 to June 30，2019 were selected as the research objects，and they were divided into experimental group（89 cases）and control group（85 cases）according to random number table method.Patients in the experimental group used continuous nutrition pump infusion for EEN，and patients in the control group used intermittent nasal feeding with bolus injection.The blood glucose-related indicators（blood glucose at 4，8，12，16，20 h，blood glucose coefficient of variation [BGcv]，incidence of hyperglycemia），insulin resistance index（HOMA-IR）value，incidence of IR，fasting insulin（FINS），maximum tolerated calories，complete enteral nutrition ratio，intestinal tolerance，fasting blood glucose（FBG）at the seventh day after treatment and total insulin use within 7 days were compared in the two groups.The serum albumin（ALB）levels were recorded 2 days before treatment and the seventh day after treatment in the two groups.Results The levels of blood glucose at 4，8，12，16，20 h，BGcv，and incidence of hyperglycemia at the seventh day after nutritional treatment in the experimental group were lower than those in the control group，and the differences were statistically significant（P＜0.05）.The HOMA-IR value，incidence of IR，FINS at the seventh day after treatment，and total insulin use within 7 days of the experimental group were lower than those of the control group，and the differences were statistically significant（P＜0.05）.The maximum tolerated calories，complete enteral nutrition ratio，and intestinal tolerance of the experimental group were higher than those of the control group at the seventh day after treatment，and the differences were statistically significant（P＜0.05）.There was no significant difference in FBG level between the two groups at the seventh day after treatment（P＞0.05）.There were no significant differences in ALB levels between the two groups of patients at 2 days before treatment and the seventh day after treatment（P＞0.05）.Conclusion Compared with the bolus injection，the infusion of nutrition pump can better improve the state of SHG and IR after nutrition support treatment.It can cooperate with the regulation of blood glucose，reduce the incidence of hyperglycemia，provide sufficient energy support for the critically ill patients，and it can improve gastrointestinal tolerance，which has the significance of popularization in the practical work.
Taylor BE，McClave SA，Martindale RG，et al.Guidelines for the provision and assessment of nutrition support therapy in the adult critically Ⅲ patient：society of critical care medicine（SCCM）and American society for parenteral and enteral nutrition（A.S.P.E.N.）[J].Crit Care Med，2016，44（2）：390-438.
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