益生菌对重型颅脑损伤患者血糖水平及预后的影响  

Effects of probiotics on blood glucose levels and clinical outcomes in patients with severe craniocerebral trauma

作　　者：谭敏[1] 卢小岚[2] 段军伟[3] 彭华[3] 朱京慈[4] 

机构地区：[1]川北医学院附属医院护理部,四川南充637000 [2]川北医学院附属医院检验科,四川南充637000 [3]川北医学院附属医院神经外科,四川南充637000 [4]第三军医大学护理学院,重庆400038

出　　处：《中华危重病急救医学》2013年第10期627-630,共4页Chinese Critical Care Medicine

基　　金：军队“十一五”面上课题资助项目（09MA009）;四川省卫生厅科研课题（110313）

摘　　要：目的探讨益生菌对重型颅脑损伤患者血糖水平及预后的影响。方法采用前瞻性随机对照研究方法，选择住本院神经外科重症监护病房（ICU）52例重型颅脑损伤患者，并按随机数字表法分为试验组及对照组，每组26例。所有患者均按照《颅脑创伤临床救治指南》的要求给予手术、脱水、抗感染、抗癫痫、营养脑细胞、保护胃黏膜等常规治疗，并于入院后24—48h内开始经鼻胃管行肠内营养；试验组在此基础上给予益生菌制剂3．5g、每日3次，使每Et益生菌总量为1×10^9个，连续使用21d。比较两组干预前及干预4、8、15、21d清晨空腹血糖水平、住院期间胰岛素使用情况、格拉斯哥昏迷评分（GCS）、ICU住院日及28d病死率。结果两组患者干预前血糖水平无明显差异，而试验组在干预8d、15d时清晨空腹血糖水平显著低于对照组（mmol／L：8d：6．6±1．2比8．0±2．7，t=-2．500，P=0．017；15d：6．1±1．4比7．2±2．2，t=-2．269，P=0．028）。试验组胰岛素使用率及使用胰岛素天数（d）均明显少于对照组[19．2％（5／26）比46．2％（12／26），X^2=4．282，P=0．039；1．6±0．9比4.3±3．1，t=-2．698，P=0．017]；试验组ICU住院日明显短于对照组（d：6．8±3．8比10．7±7.3，t=-2，123，P=0．034）。试验组和对照组干预前后GCS分值（分，干预前：6．3±1．0比6．4±1．0，t=-0．408，P=0．685；干预21d：10．1±4．0比9．6±4．3，t=0．435，P=0．665）及28d病死率[11．5％（3／26）比19．2％（5／26），X^2=0．148，P=0．701]比较差异均无统计学意义。结论益生菌有利于重型颅脑损伤患者的血糖控制，但其内在机制以及对远期预后的影响还需要进一步的研究探讨。Objective To investigate the effects of probiotics on blood glucose levels and clinical outcomes in patients suffering from severe craniocerebral trauma. Methods A prospective randomized control study was conducted. Fifty-two severe cranioeerebral trauma patients admitted to intensive care unit （ICU） were randomized into experimental or control group （each n =26）. All patients received conventional treatment according to Guidelines for the Clinical Management of Traumatic Brain Injury and enteral nutrition within 24-48 hours after admission through nasogastrie tube. In addition, the experimental group received 1 x 109 bacteria of viable probioties （Golden Bifid, 3.5 g for 3 times per day ） per day for 21 days. The fasting blood glucose levels were determined in the morning before intervention and on day 4, 8, 15, 21 after intervention. Amount of insulin used during hospitalization, Glasgow coma scale （GCS） scores, length of ICU stay, and 28-day mortality rate were studied. Results There was no difference in term of the blood glucose levels between two groups before intervention. On day 8 and 15 after intervention, significantly lower levels of fasting blood glucose （mmol/L） were observed in the experimental group compared with those of the control group （ 8 days ： 6.6 ± 1.2 vs. 8.0 ± 2.7, t=-2.500, P=0.017; 15 days： 6.1 ± 1.4 vs. 7.2 ± 2.2, t=-2.269, P=0.028）. There were significantly less patients treated with insulin or shorter days of insulin therapy in experimental group than in control group [ 19.2% （5/26） vs. 46.2% （12/26）, X^2=4.282, P=0.039; 1.6 ± 0.9 vs. 4.3 ± 3.1, t=-2.698, P=0.017]. The length of ICU stay （days） was significantly shorter in the experimental group than that of control group （6.8 ± 3.8 vs. 10.7 ±7.3, t =-2.123, P=0.034）. No significant differences were found about the GCS scores （before intervention： 6.3 ± 1.0 vs. 6.4 ± 1.0, t=-0.408, P=0.685; 21 days after intervention： 10.1 ±4.0 vs. 9.6 ±4.3, t= 0.435, P=0.665） and 28-day

关 键 词：颅脑损伤 益生菌 高血糖 

分 类 号：R651.1[医药卫生—外科学]