Objective To investigate the clinical effect of early use of
enteral nutrition therapy in
elderly diabetic
patients suffering from severe lower
respiratory tract infection .
Methods A prospective,randomized,open,controlled trial was conducted.
Patients aged ≥ 60 years old with
diabetes mellitus complicated by severe lower
respiratory tract infection admitted to Department of
Geriatrics of the Ninth People's
Hospital Affiliated to Shanghai Jiaotong
University School of
Medicine from July 2013 to June 2015 were enrolled,and they were divided into the
observation group (nasogastric tube infusion of fresubin) and
control group (ordinary liquid
diet ) according to the random number table
method ,with 60
patients in each group.
Nutritional status ,
inflammation state and immunological indexes before
treatment (0 day) and 4,7,14 days
after treatment ,the outcome of the
disease and the
nutrition related
complications were compared between two groups.Results
After treatment ,
serum albumin (ALB),pro-
albumin (PA),
immunoglobulin A and G (
IgA ,
IgG ) were significantly increased compared with those before
treatment in both groups [at 7 days,ALB (g/L)28.37 ± 0.40 vs.26.72 ± 0.37 in
control group ,29.12 ± 0.25 vs.26.86 ± 0.26 in
observation group;PA (mg/L)53.80 ± 6.28 vs.43.76 ± 6.93 in
control group ,58.46 ± 8.70 vs.44.68 ± 7.33 in
observation group;
IgG (g/L)11.62±4.72 vs.9.98±3.71 in
control group ,13.36±4.58 vs.9.88±3.27 in
observation group;
IgA (g/L)2.31 ±0.35 vs.1.50±0.39 in
control group ,3.07±0.48 vs.1.37±0.29 in
observation group;all P < 0.05].Compared with the
control group ,the level of PA in
observation group was significantly increased from 7 days on (mg/L58.46 ± 8.70 vs.53.80 ± 6.28,P < 0.05),while ALB,
IgG ,
IgA levels in
observation group increased at 14 days [ALB (g/L)33.24 ± 0.45 vs.30.76±0.79,
IgG (g/L)15.03 ±3.73 vs.11.45 ±2.83,
IgA (g/L)3.56±0.32 vs.2.50±0.16,all P < 0.05].The levels of
C-reactive protein (CRP) and
procalcitonin (PCT) in both groups gradually lowered,but they were significantly lower in
observation group than those in the
control group from 4 days on [CRP (mg/L)17.72±4.23 vs.20.96±5.83,PCT (ng/L)123±37 vs.257±88,both P < 0.05],up to 14 days.The
hospital mortality rate of the
observation group was lowered compared with that of the
control group (6.67% vs.8.89%),and the duration of
mechanical ventilation was significantly shortened (hours145.00±19.39 vs.193.00± 18.97,P < 0.05),
insulin dosage was also significantly decreased (U33.52 ± 5.74 vs.49.71 ± 6.99,P < 0.05).There was no significant difference in the
incidence of abdominal distension,
diarrhea and reflux of gastric contents between the two groups,and they were relieved
after treatment and had no influence on further
enteral nutrition therapy .Conclusion Early
administration of the complicated
enteral nutrition in
elderly diabetic
patients with severe lower
respiratory tract infection cannot only decrease the levels of pro-inflammatory factors in
patients ,but also shorten the duration of
mechanical ventilation ,enhance
immunity ,improve the curative effect with little influence on the
blood glucose level.