Effect Of Periodic And Continuous Enteral Nutrition Infusion On Glucose Variability And Prognosis In Critically Ill Patients

The critical patients are in a state of stress,accompanied by metabolic disorders such as hyperglycemia and insulin resistance to varying degrees.The blood glucose of critical patients can be controlled at a stable level to minimize blood glucose variability,which can reduce mortality and improve prognosis.Enteral nutrition is the preferred nutritional way for critically ill patients,which is more in line with the physiological characteristics of the body.It can maintain the integrity of intestinal structure and function,reduce bacterial and endotoxin translocation,and maintain the normal function of the immune system.It can not only improve the nutritional level of critically ill patients,but also reduce the risk of infection,complications,shorten hospitalization time and even improve prognosis.However,it is not clear whether periodic and continuous enteral nutrition infusion has an impact on blood glucose variability and prognosis in critically ill patients.It is worth discussing which enteral nutrition infusion method is more conducive to maintaining blood glucose stability in critically ill patients.ObjectiveTo investigate the effects of periodic and continuous enteral nutrition infusion on blood glucose variability and prognosis in critically ill patients.MethodsA series of 160 ICU critically ill patients admitted from June 2018 to January2019 were prospectively enrolled.They were randomly divided into periodic enteral nutrition infusion group(periodic group)and continuous enteral nutrition infusion group(continuous group),80 cases in each group.Both groups used the same enteral total nutrition preparation(TPF-D,trade name:Ruidai).The daily demand of patients was transfused by enteral nutrition micropump.The periodic group was transfused for16 hours and the continuous group was transfused for 24 hours.The two groups followed the same principle of blood glucose control.The following indicators were collected in two groups:(1)General data:demographic characteristics,basic disease status and Acute Physiology and Chronic Health Evaluation II(APACHE II)within24 hours of ICU admission and the Sequential Organ Failure Assessment(SOFA);(2)Blood glucose variability:blood glucose levels at different periods of ICU admission were calculated to obtain average blood glucose(GLUave)and standard deviation(GLUsd),the blood glucose coefficient variability(GLUcv)was calculated according to the formula:GLUcv=GLUsd/GLUave×100%;⑶Daily average insulin dosage:daily average insulin dosage during ICU stay;⑷Enteral nutrition complications:the complications of aspiration,gastric retention,diarrhea and inhalation pneumonia related to enteral nutrition infusion were recorded in two groups;⑸Prognostic indicators:mortality rate of ICU stay on 28d,ICU length of stay and total length of stay.ResultsThere was no significant difference in general data between the continuous group and the periodic group(P>0.05).The GLUcv of the continuous group(23.6±6.7%vs.26.4±7.8%,t=2.436,P=0.016)was significantly smaller than that of the periodic group(P<0.05).The daily average insulin dosage in the continuous group(15.2±4.4U vs.17.5±5.1U,t=3.054,P=0.003)was significantly less than that in the periodic group,and the difference was statistically significant(P<0.05).The incidences of aspiration,gastric retention,diarrhea,aspiration pneumonia and enteral nutrition-related complications were 7.5%and 10.0%,26.3%and 28.8%,21.3%and25.0%respectively,and 5.0%and 7.5%respectively in the periodic group and the continuous group,respectively.There was no significant difference in complications related to enteral nutrition between the two groups(P>0.05).The 28-day mortality of ICU in the continuous group(22.5%vs.10.0%,χ~2=4.592,P=0.032)was significantly lower than that in the periodic group,the length of stay in ICU(18.2±5.5d vs.15.6±4.3d,t=3.331,P=0.001)was significantly shorter than that in the periodic group,and the total length of stay(25.4±7.6d vs.22.7±6.5d,t=2.415,P=0.017)was significantly shorter than that in the periodic group,with statistical significance(P<0.05).ConclusionCompared with periodic enteral nutrition infusion,continuous enteral nutrition infusion has less effect on blood glucose variability in critically ill patients,which is more conducive to maintaining blood glucose stability and improving prognosis,and does not increase the risk of complications of enteral nutrition.