两种肠内营养混悬液在糖尿病伴高尿酸血症患者中的应用研究

发布时间：2018-01-14 15:43

本文关键词：两种肠内营养混悬液在糖尿病伴高尿酸血症患者中的应用研究　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探究康全力和能全力两种肠内营养混悬液对2型糖尿病伴高尿酸血症患者血糖、胰岛素用量、血尿酸、白蛋白、前白蛋白、甘油三酯、胆固醇等代谢指标和安全性指标的影响,分析两种肠内营养混悬液在2型糖尿病伴高尿酸血症患者中应用的有效性、安全性,为临床中合理选用肠内营养混悬液提供一定的理论依据。方法将符合纳入标准的74例2型糖尿病伴高尿酸血症患者按照随机原则分为能全力组和康全力组,每组37名患者,分别经鼻胃管给予能全力或康全力肠内营养混悬液并记录两组患者的液体出入量及胰岛素用量。在给予两种肠内营养混悬液前以及肠内营养的第7、10天分别采集两组患者的空腹静脉血,监测其血糖、血尿酸、白蛋白、前白蛋白、甘油三酯、胆固醇等代谢指标的水平,并详细记录患者在肠内营养期间发生不良反应与并发症的情况作为安全性指标。应用重复测量、t检验、c2检验等统计学方法对收集的资料进行统计学分析。结果两组最终各收集有效病例35份。1.两组患者间的一般资料及肠内营养前各指标的基线值均无显著性差异(P0.05),具有可比性。2.肠内营养期间两组患者胰岛素用量的重复测量分析发现,时间效应、处理效应以及交互效应均有统计学意义(P时间=0.039,P处理=0.025,P交互0.001)。在不同时间点对两组患者间胰岛素用量进行比较,康全力组患者肠内营养第7、10天的胰岛素用量显著低于能全力组(t=2.206,P=0.031;t=3.579,P=0.001)。3.两组患者血糖水平重复测量分析发现,时间效应、处理效应以及交互效应均有统计学意义(P时间=0.006,P处理0.001,P交互0.001)。在不同时间点对两组患者间血糖水平进行比较,康全力组患者肠内营养第7、10天的血糖水平显著低于能全力组(t=4.071,P0.001;t=4.799,P0.001)。4.肠内营养期间两组患者出入量的变化均无统计学意义(P0.05),所以可排除出入量对两组患者血尿酸水平的影响。肠内营养期间康全力组患者血尿酸水平由(494.83±60.82)μmol/L上升到(499.51±63.20)μmol/L,但两组患者血尿酸水平重复测量分析中的时间效应、处理效应以及交互效应均无统计学意义(P时间=0.578,P处理=0.893,P交互=0.066)。5.肠内营养期间两组患者白蛋白水平仅时间效应有统计学意义(P时间0.001),其它比较均无统计学意义(P0.05)。两组患者前白蛋白水平重复测量分析发现,时间效应、处理效应和交互效应均有统计学意义(P时间0.001,P处理=0.044,P交互0.001)。在不同时间点对两组患者间前白蛋白水平进行比较,康全力组患者肠内营养第10天的前白蛋白水平显著高于能全力组(t=2.823,P=0.006)。6.肠内营养期间,虽然能全力组患者甘油三酯水平有所下降,康全力组患者甘油三酯水平有所上升,但两组患者甘油三酯水平的时间效应、处理效应、交互效应以及两组患者间同期甘油三酯水平比较,差异均无统计学意义(P0.05)。两组患者胆固醇水平的时间效应、处理效应以及交互效应均有统计学意义(P时间0.001,P处理=0.043,P交互=0.036)。在不同时间点对两组患者间胆固醇水平进行比较,康全力组患者肠内营养第10天的胆固醇水平显著高于能全力组(t=2.435;P=0.018)。7.对两组患者肠内营养期间出现的不良反应以及并发症情况进行比较,差异不具有显著性(P0.05)。结论短期(10天)内应用康全力较能全力具有血糖水平稳定、胰岛素用量少,且能更好的改善蛋白质代谢的优点。但能全力能够更好的改善患者胆固醇水平。短期(10天)内两者对血尿酸、甘油三脂水平等均未产生明显影响,且均具有良好的安全性。因此,这两种肠内营养混悬液对2型糖尿病伴高尿酸血症患者均具有一定的疗效,并且康全力是此类患者短期(10天)内应用更为理想的营养制剂,但如果长时间使用需关注患者血尿酸水平升高的风险。
[Abstract]:Objective to explore the best and to Kang two Enteral Nutritional Suspension on type 2 diabetes mellitus patients with hyperuricemia, blood glucose, insulin dosage, blood uric acid, albumin, pre albumin, triglyceride, cholesterol and other metabolic effects and safety indexes, analysis of two kinds of Enteral Nutritional Suspension in the effectiveness of the application of hyperuricemia in patients with type 2 diabetes with safety, for reasonable selection of Enteral Nutritional Suspension to provide a theoretical basis for clinical application. Methods 74 patients met the inclusion criteria of type 2 diabetes mellitus complicated with hyperuricemia were randomly divided into the study group and to Kang group, each group had 37 patients, respectively by nasogastric tube or to Kang to Enteral Nutritional Suspension and record the two groups of patients of liquid intake and output the amount of insulin given in two. In the former Enteral Nutritional Suspension and enteral nutrition in the 7,10 don't talent acquisition Fasting venous blood of two groups of patients, monitor their blood glucose, blood uric acid, albumin, pre albumin, triglyceride, cholesterol metabolism index level, and during enteral nutrition in patients with documented adverse reactions and complications as safety index. Application of repeated measurement, t test data, the statistical method of C2 test the collected for statistical analysis. Results there were no significant differences between the two groups of general information and intestinal each collection of 35 effective cases of.1. between the two groups in the nutrition of each index before the baseline (P0.05), it can be compared with repetitive measurement and analysis of two groups of patients with insulin dosage of.2. during enteral nutrition found the effect of time, treatment effects and interactions were statistically significant (P =0.039, P =0.025, P 0.001 interactive). At different time points of two groups of patients were compared between the dosage of insulin, to Kang group Enteral nutrition insulin dosage in 7,10 days was significantly lower than that of the study group (t=2.206, P=0.031; t=3.579, P=0.001).3. two group the blood glucose levels of patients with repeated measurement analysis, time effect, treatment effects and interactions were statistically significant (P =0.006, P 0.001, P 0.001 interactive) at different time points to. Two groups of patients were compared between the blood glucose level, Kang group full enteral nutrition in patients with 7,10 days blood glucose level was significantly lower than the study group (t=4.071, P0.001; t=4.799, P0.001).4. during enteral nutrition in two groups and changes were not statistically significant (P0.05), so we can exclude the influence of quantity of two groups of patients with serum uric acid levels. During enteral nutrition Kang group to serum uric acid levels by (494.83 + 60.82) mol/L to (499.51 + 63.20) mol/L, but the two groups of serum uric acid in patients with repeated measurement and analysis of time effect in the Office Physical effects and interaction effects were not statistically significant (P =0.578, P =0.893, P interactive =0.066) was statistically significant.5. during enteral nutrition in patients with albumin levels in the two groups only time effect (P 0.001), the other had no statistical significance (P0.05). The two groups of patients with serum prealbumin level analysis of repeated measurement that time effect, treatment effects and interaction effects were statistically significant (P 0.001, P =0.044, P 0.001 interactive). At different time points of two groups of patients were compared between the level of serum prealbumin, albumin levels to Kang group before enteral nutrition in patients with tenth days were significantly higher than those in the study group (t=2.823, P=0.006.6.) during enteral nutrition, while the study group triglyceride levels in patients with decreased triglyceride levels in patients with Kang group all increased, but the two groups of the patients with triglyceride levels between the treatment effect and interaction effect. Comparison of effect between the two groups of patients during the same period and triglyceride levels, there were no significant differences (P0.05). The effect of time in patients with cholesterol levels in the two groups, the treatment effect and the interactions were statistically significant (P 0.001, P =0.043, P =0.036 interactive). At different time points of two groups of patients were compared between cholesterol levels Kang group, full enteral nutrition in patients with tenth days of cholesterol level was significantly higher than that of the study group (t=2.435; P=0.018) comparing.7. of two groups of patients with enteral nutrition during the adverse reactions and complications, the difference was not significant (P0.05). Conclusion the short-term (10 days) in the application to more fully Kang with stable blood sugar levels, less dosage of insulin, improve the protein metabolism and the advantages of better. But to improve cholesterol levels in patients with better short-term (10 days) in both the blood uric acid, glycerol Were not obvious effects of three lipid levels, and has good safety. Therefore, the two Enteral Nutritional Suspension has certain curative effect on type 2 diabetes mellitus patients with hyperuricemia, and to such patients is Kang short-term (10 days) in the application of more ideal nutrition preparations, but if the risk is used for a long time need to pay attention to patients with elevated level of serum uric acid.

【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

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