Comparison of effects of using different enteral nutrient agents for intensive care unit patients with hyperglycemia under mechanical ventilation after extracorporeal circulation cardiac surgery / 中国中西医结合急救杂志

ABSTRACT

Objective To observe the effects of nasal feeding with different enteral nutrition (EN) agents, TPF-D emulsion and Briprin (SP) suspension on blood glucose level in patients with hyperglycemia under mechanical ventilation after cardiac surgery of extracorporeal circulation (CPB). Methods Forty patients with mechanical ventilation and hyperglycemia after CPB cardiac surgery admitted to the Department of Intensive Care Unit (ICU) of Jinhua People's Hospital from August 2016 to October 2018 were selected. According to the different EN preparations given after the surgery, the patients were divided into two groups a TPF-D group (21 cases) and a Briprin group (19 cases). Both groups were given reasonable analgesia, sedation and other conventional treatment to maintain the hemodynamic stability and balances between water electrolytes and acid-base. EN therapy was applied within 24 ~48 hours after ICU admission and caloric requirements were calculated according to ideal body weight. The EN treatment in TPF-D group was given by TPF-D nasal feeding, the drip rate started from 20-30 mL/h and gradually increased to 50-100 mL/h according to patients' tolerance; in the Briprin group, EN was given by nasal feeding of SP, and the feeding mode was the same as that of TPF-D group. The mechanical ventilation time, postprandial 2 hours blood glucose level and blood glucose increase rate of the two groups were observed; the glycosylated albumin (GA) and serum triglyceride (TG) levels were measured 3 days after EN administration, and the first postoperative defecation time was also observed in the two groups. Results After EN therapy, there were no statistically significant differences in mechanical ventilation time and TG level after 3 days of EN treatment between the TPF-D group and the SP group [mechanical ventilation time (hours) 31.52±19.56 vs. 27.26±14.35, TG (mmol/L) after 3 days of EN therapy 1.32±0.37 vs. 1.62±0.57, both P > 0.05]. The glucose level and glucose increase rate at postprandial 2 hours, and GA level after 3 days of EN therapy in TPF-D group were obviously lower than those in the SP group [glucose level 2 hours postprandial (mmol/L) 7.68±1.20 vs. 11.60±1.69, the glucose increase rate at 2 hours postprandial (-0.01±0.15)% vs. (0.39±0.24)%, and GA after 3 days of EN therapy (12.81±1.64)% vs. (16.32±2.35)%, all P < 0.01]. The time of the first bowel movement in the TPF-D group was earlier than that in the SP group (days 2.48±0.51 vs. 3.84±0.69, P < 0.01). Conclusion The effect of applying TPF-D EN emulsion was less than that of SP suspension on glucose level in post-operative CPB patients with hyperglycemia and after mechanical ventilation, showing when using TPF-D, the stability of blood glucose is better and defecation earlier.