Yao Huan, Dong Yukang, Jiang Yan, Xiao Gui, Gao Hai, Guo Jia
Xiangya School of Nursing, Central South University, Changsha, China.
Department of Nursing, Guizhou Provincial People's Hospital, Guiyang, China.
J Clin Nurs. 2025 Nov;34(11):4654-4663. doi: 10.1111/jocn.17714. Epub 2025 Mar 3.
This study aimed to investigate the incidence and identify risk factors of stress hyperglycaemia among patients who received enteral nutrition (EN) in the intensive care unit (ICU).
Stress hyperglycaemia is common among ICU patients receiving EN and is related to worse outcomes. However, the factors associated with stress hyperglycaemia during EN remain unclear, especially among patients who are not diagnosed with diabetes.
A retrospective cohort study.
Electronic medical records of 614 non-diabetic patients receiving EN at two ICUs in Guizhou Provincial People's Hospital were reviewed. Patients were classified into hyperglycemic and non-hyperglycemic groups. Social demographics, clinical characteristics, treatment regimens, nutrition therapy, and point-of-care blood glucose values were collected. Univariate and multivariable analyses identified risk factors for stress hyperglycaemia. This study followed the STROBE guideline.
The incidence of stress hyperglycaemia among ICU patients without diabetes receiving EN was 35.50%. Multivariable analysis revealed that obesity (BMI ≥ 28 kg/m), high carbohydrate intake (> 5.0 g/kg/day), and the use of semi-elemental EN solutions were independent risk factors for stress hyperglycaemia. In contrast, a moderate carbohydrate intake (3.0-3.9 g/kg/day) was associated with a significantly lower risk of stress hyperglycaemia.
The 35.50% of ICU patients without diabetes experienced stress hyperglycaemia during EN. Potential risk factors included BMI ≥ 28 kg/m, high carbohydrate intake (> 5.0 g/kg/day), and the use of semi-elemental EN solutions. A moderate carbohydrate intake (3.0-3.9 g/kg/day) was protective. Future research should explore optimal carbohydrate intake ranges and personalised nutrition protocols to reduce stress hyperglycaemia in critically ill patients.
Reducing stress hyperglycaemia in ICU patients without diabetes receiving EN is crucial. Recommendations include monitoring patients with BMI ≥ 28 kg/m and considering moderate carbohydrate intake (3.0-3.9 g/kg/day), and reasonably selecting the type of enteral nutrition solution based on the patient's individual condition.
本研究旨在调查重症监护病房（ICU）中接受肠内营养（EN）的患者应激性高血糖的发生率，并确定其危险因素。
应激性高血糖在接受EN的ICU患者中很常见，且与较差的预后相关。然而，EN期间与应激性高血糖相关的因素仍不清楚，尤其是在未被诊断为糖尿病的患者中。
一项回顾性队列研究。
回顾了贵州省人民医院两个ICU中614例接受EN的非糖尿病患者的电子病历。患者被分为高血糖组和非高血糖组。收集了社会人口统计学、临床特征、治疗方案、营养治疗和即时血糖值。单因素和多因素分析确定了应激性高血糖的危险因素。本研究遵循STROBE指南。
ICU中接受EN的非糖尿病患者应激性高血糖的发生率为35.50%。多因素分析显示，肥胖（BMI≥28kg/m）、高碳水化合物摄入量（>5.0g/kg/天）和使用半要素EN溶液是应激性高血糖的独立危险因素。相比之下，中等碳水化合物摄入量（3.0-3.9g/kg/天）与应激性高血糖风险显著降低相关。
35.50%的ICU非糖尿病患者在EN期间发生了应激性高血糖。潜在危险因素包括BMI≥28kg/m、高碳水化合物摄入量（>5.0g/kg/天）和使用半要素EN溶液。中等碳水化合物摄入量（3.0-3.9g/kg/天）具有保护作用。未来的研究应探索最佳碳水化合物摄入量范围和个性化营养方案，以降低危重症患者的应激性高血糖。
降低ICU中接受EN的非糖尿病患者的应激性高血糖至关重要。建议包括监测BMI≥28kg/m的患者，考虑中等碳水化合物摄入量（3.0-3.9g/kg/天），并根据患者个体情况合理选择肠内营养溶液的类型。
