益生菌联合早期肠内营养对合并应激性高血糖的重症脑卒中患者血糖调控及预后的影响

目的 探讨益生菌联合早期肠内营养(EEN)对合并应激性高血糖的重症脑卒中患者血糖调控及预后的影响,为此类患者的治疗提供参考。 方法 选择2017年5月1日至2019年5月1日我院神经内科收治的合并应激性高血糖的重症脑卒中患者64例为研究对象,随机分为对照组和观察组,各32例。对照组患者在入院48 h内给予EEN,观察组患者在对照组基础上给予双歧杆菌乳杆菌三联活菌片鼻饲。比较两组患者治疗后血糖变异性、胰岛素使用强度、低血糖发生率、炎症反应指标水平、应激反应指标水平、胃肠道不良反应,5 d内肠内营养达标率、营养状态指标水平、医院获得性肺炎(HAP)发生率及病死率。 结果 治疗后,观察组患者血糖变异性较小,胰岛素使用强度降低,低血糖发生率降低,炎症反应指标、应激反应指标水平均低于对照组；胃肠道不良反应中腹泻发生率降低,肠内营养达标率升高,血清白蛋白、前白蛋白水平均高于对照组,医院获得性肺炎发生率降低。两组患者病死率差异无统计学意义(12.50% vs 18.75%；χ2=0.474,P=0.491)。 结论 对于合并应激性高血糖的重症脑卒中患者,益生菌联合EEN有助于控制血糖稳定性,降低胰岛素使用强度及低血糖发生率,同时降低炎症及应激反应,提高患者肠内营养耐受性,改善患者营养状态,降低HAP发生率。

Effects of probiotics combined with early enteral nutrition on blood glucose control and prognosis in patients with severe stroke complicated with stress hyperglycemia

Objective To explore the effect of probiotics combined with early enteral nutrition (EEN) on blood sugar regulation and prognosis in severe stroke patients with stress hyperglycemia, and provide a reference for the treatment. Methods A total of 64 severe stroke patients with stress hyperglycemia admitted to the Neurology Department of our hospital from May 1,2017 to May 1,2019 were randomly divided into the control group (n=32) or the observation group (n=32). Both groups were given early enteral nutrition within 48 hours after admission. The observation group was given additional Viable Bifidobacterium and Lactobacillus Triplet Tablets through nasal feeding. The blood sugar variability, insulin use, incidence of hypoglycemia, inflammatory factor, stress response index, incidence of complications of enteral nutrition, ratio of enteral nutrition achievement in 5 days, nutritional status indicators, incidence of hospital acquired pneumonia and fatality rate after treatment were compared between the two groups. Results In the observation group, blood sugar variability, insulin use, incidence of hypoglycemia, inflammatory factor, incidence of diarrhea and stress response index were lower; more patients achieved enteral nutrition criterion, and the levels of serum albumin and prealbumin were higher than those in the control group. The incidence of hospital acquired pneumonia was lower in observation group. The fatality rate in the 2 groups were not significantly different (12.50% vs 18.75%; χ2=0.474, P=0.491). Conclusion For severe stroke patients with stress hyperglycemia, probiotics combined with early enteral nutrition can help control blood sugar, reduce insulin use, incidence of hypoglycemia, inflammation and stress response, increase the tolerance of patients with enteral nutrition, improve the nutritional status of patient and reduce the incidence of hospital acquired pneumonia.