泵注实施早期肠内营养改善危重症高血糖状态和胰岛素抵抗

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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.

Key words： Continuous nutrition pump infusion Early enteral nutrition Critical illness Stress hyperglycemia Blood glucose coefficient of variation Insulin resistance index

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