应激性高血糖对胃癌术后肠内营养实施的影响及护理策略

目的:观察应激性高血糖(SHG)对胃癌术后营养治疗实施的影响,并总结相关护理策略。方法:回顾性分析2017年1月至2019年12月在我院接受胃癌根治术的病人,病人术后均接受早期肠内营养(EN)治疗,以是否发生SHG将病人分为SHG组(32例)和非SHG组(63例)。收集术前一般资料,术后胃肠道功能恢复时效,EN不耐受症状,术前及术后血糖不稳定指数(GLI),以及术后C-反应蛋白(CRP)。结果:SHG组病人术后恢复经口进食时间(t=3.311;P=0.001)和术后住院日(t=3.031;P=0.003)均显著长于非SHG组。SHG组病人术后EN不耐受症状的发生率显著高于非SHG组(χ^2=8.273,P=0.004)。SHG组病人术前GLI(t=7.561;P<0.01)及术后GLI(t=6.977,P<0.01)均显著高于非SHG组病人;术前GLI预测术后SHG发生的敏感性为84.38%,特异性为82.54%。SHG组病人术后第3天CRP显著高于非SHG组病人(45.9±11.3)vs(26.7±9.8)mg/L,t=8.567,P<0.01],且SHG组病人术后GLI与CRP呈现显著正相关(r=0.656,P<0.01)。结论:术后并发SHG影响胃癌术后康复及EN顺利实施,而术前GLI对胃癌术后SHG的发生具有一定预测价值。

Effects of stress hyperglycemia on the provision of enteral nutrition after gastric cancer surgery and its related nursing strategy

Objective:Our study was aimed to investigate the effects of postoperative stress hyperglycemia(SHG)on the provision of postoperative nutritional support in gastric cancer patients,and to summarize the nursing strategy.Methods:Retrospective analysis of patients who underwent radical gastrectomy in our hospital from January 2017 to December 2019.All patients received enteral nutrition(EN)therapy after operation,and were divided into SHG group(32 cases)and non-SHG group(63 cases)according to whether SHG occurred.The postoperative rehabilitation process,incidence of intolerant symptoms due to EN,the predictive value of the preoperative and postoperative blood glucose instability index(GLI)for postoperative SHG,and the relationship between postoperative GLI and C-reactive protein(CRP)were analyzed.Results:The postoperative recovery time of oral feeding in the SHG group(t=3.311,P=0.001)and postoperative hospital stay(t=3.031,P=0.003)were significantly longer than those in the non-SHG group.The incidence of postoperative EN intolerant symptoms in the SHG group was significantly higher than that in the non-SHG group(χ^2=8.273,P=0.004).The preoperative GLI(t=7.981,P<0.01)and postoperative GLI(t=4.272,P<0.01)in the SHG group were significantly higher than those in the control group;the sensitivity of the preoperative GLI to predict the occurrence of postoperative SHG was 84.38%,the specificity is 82.54%.The CRP in the SHG group was significantly higher than that in the non-SHG group at Day 3 after surgery(45.9±11.3)vs(26.7±9.8),t=8.567,P<0.01],and the GLI and CRP in the SHG group showed a significant positive correlation(r=0.656,P<0.01).Conclusion:Postoperative SHG affects the postoperative recovery process and the success provision of EN in patients with gastric cancer,and preoperative GLI has a certain predictive value for the occurrence of SHG after surgery.