睡前加餐对老年住院慢加急性肝衰竭患者能量代谢及预后的影响

Effect of late night snack on energy metabolism and prognosis in elderly hospitalized patients with acute-on-chronic liver fail-ure

中文关键词: 老年  慢加急性肝衰竭  睡前加餐  能量代谢  预后

英文关键词: elderly  acute-on-chronic liver failure  late night snack  energy metabolism  prognosis

中文摘要:

      目的 探讨睡前加餐对老年住院慢加急性肝衰竭(ACLF)患者能量代谢及预后的影响,旨在为其临床诊治和预后判断提供依据.方法 选择2020 年1 月—12 月于空军军医大学第二附属医院收治的79 例老年ACLF患者为研究对象,根据随机数字表法分为对照组(n =40)和观察组(n =39).由专业的营养科医师计算每日总热量,对照组患者常规 3餐饮食,而观察组每日日间3 餐,每餐均减少67 kcal(相当于16.7g碳水化合物)食物,在睡前1h时进行加餐.干预时间为2 周.比较2 组2 周后的体质量指数(BMI)、糖代谢指标、营养状况、生化指标、生活质量及28d死亡率等指标.结果 干预后观察组空腹血糖水平较对照组显著升高,而低血糖发生率和胰岛素抵抗指数较对照组显著下降(均P＜0.05).与对照组相比,观察组干预后NRS 2002≥3 的比例显著下降,28 d死亡率显著降低(均P＜0.05).与对照组相比,干预后观察组白蛋白、前白蛋白及凝血酶原活动度均显著升高(均P＜0.05).干预后,观察组总分和生理方面得分较对照组显著上升,提示该维度患者的生活质量显著好转.结论 老年ACLF患者睡前加餐能够降低低血糖发生率,改善患者的营养状态和生活质量,降低28d死亡率,具有一定临床价值.

英文摘要:

      Objective To investigate the effect of late night snack on energy metabolism and prognosis in elderly hospi-talized patients with acute-on-chronic liver failure(ACLF),and provide a basis for patient's clinical diagnosis,treatment,and prognosis judgment.Methods A total of 79 elderly ACLF patients admitted to Second Affiliated Hospital of Air Force Medical University from January to December 2020 were selected as the study subjects.They were divided into control group(n =40)and observation group(n =39)according to random number table method.The patient's total daily calories were calculated by a professional nutritionist.The patients in the control group were fed 3 meals regularly.The patients in the observation group had three meals a day during the day,but each meal reduced67 kcal of food(equivalent to 16.7 g of carbohydrates),and a late night snack was added 1 hour before bedtime.The duration of intervention was 2 weeks.The body mass index(BMI),glucose metabolism indexes,nutritional status,biochemical indexes,quality of life and 28-day mortality were compared be-tween the two groups.Results After intervention,the fasting blood glucose level of the observation group was significantly higher than that of the control group,while the incidence of hypoglycemia and insulin resistance index were significantly lower than those of the control group(all P＜0.05).Comparedwiththe control group,the proportionof patientswith NRS2002≥3 in the observation group decreased significantly after intervention,and the 28-day mortality rate decreased significantly(all P＜0.05).Compared with the control group,the levels of albumin,prealbumin and prothrombin activity in the observation group significantly increased after intervention(all P＜0.05).After intervention,the total score and physiological scores of the observation group were significantly higher than those of the control group,indicating that the quality of life of patients in these dimensions was significantly improved.Conclusion In elderly ACLF patients,the late night snack can reduce the incidence of hypoglycemia,improve the nutritional status and quality of life of patients,and reduce the 28-day mortality,which has certain clinical value.