益生菌联合乳果糖对重症心脏瓣膜病术后腹腔内压的影响  

Effect of intra-abdominal pressure in patients of advanced valvular heart disease using probiotics and lactulose after operation

作　　者：王翠苹[1] 易松[2] 杨嵩[1] 张宝[1] 张文波[1] 李华明[1] 唐白云[1] 

机构地区：[1]中山大学附属第一医院心外ICU,广州510080 [2]南方医科大学南方医院

出　　处：《中华普通外科学文献（电子版）》2014年第6期35-39,共5页Chinese Archives of General Surgery(Electronic Edition)

基　　金：广东省科技计划项目(2008B060600064)

摘　　要：目的：探讨益生菌联合乳果糖对重症心脏瓣膜病患者术后腹腔内压（IAP）及胃肠功能、预后的影响。方法2013年8月至2014年8月入选的56例患者并被随机分为两组，各28例。治疗组术后第1天开始使用益生菌联合乳果糖，持续至术后第7天；对照组未使用益生菌及乳果糖，其他治疗同治疗组。通过膀胱测压法测量两组患者术前和术后第1~5天的IAP，记录两组患者术后首次排便时间、ICU停留时间、术后住院时间；记录两组患者术后腹腔高压（IAH）、腹腔间隔综合征（ACS）、胃肠功能障碍及死亡例数。结果治疗组与对照组术前IAP差异无统计学意义[（3.96±1.63）mmHg vs（3.63±1.58） mmHg，t=0.44，P=0.63]，两组术后IAP均呈先上升后下降趋势，治疗组和对照组分别在术后第3、4天达最高点，术后第1天两组HAP水平差异无统计学意义[（11.87±2.22）mmHg vs （11.58±2.76）mmHg，t=1.62，P=0.11]，术后第2天开始差异有统计学意义（术后第2~5天的t值分别为2.24、2.47、4.23、4.92，P值分别为0.04、0.02、0.00、0.00）；两组术后首次排便时间（t=2.36，P=0.03）、ICU停留时间（t=3.87，P=0.00）及术后住院时间（t=2.76， P=0.01）之间差异均有统计学意义；治疗组与对照组术后IAH发生率（14.28%vs 39.28%，χ2=4.46， P=0.04）、胃肠功能障碍发生率（7.14%vs 28.57%，χ2=4.38，P=0.04）方面差异均有统计学意义。结论重症瓣膜病术后早期联合使用益生菌和乳果糖可有效降低IAP，改善胃肠功能，降低ICU停留时间和术后住院时间。Objective To evaluate the effect of intra-abdominal pressure and the change of gastrointestinal function in patients of advanced valvular heart disease using probiotics and lactulose after operation. Methods From August 2013 to August 2014, fifty-six patients were selected and divided into two groups randomly：28 cases in the treatment group, using probiotics and lactulose the first day after operation until the seventh day. The other 28 cases were the control group, undergoing the same procedure except for probiotics and lactulose. IAP was measured preoperatively, the first, second, third, fourth, and fifth day after operation in the two groups through measuring the bladder pressure. Postoperative defecation time for the first time （d）, ICU stay time （h）, postoperative length of hospital stay （d）, incidence of IAH/ACS gastrointestinal dysfunction and mortality in the two groups were also recorded. Results There was no statistically significant difference between the two groups in IAP preoperatively [（3.96±1.63） mmHg vs （3.63±1.58） mmHg, t=0.44, P=0.63] and one day after operation [（11.87±2.22） mmHg vs （11.58±2.76） mmHg, t=1.62, P=0.11]. Postoperative IAP in the two groups increased at first and then decreased, reaching up to the peak at the third day in treatment group and the fourth day in the control group. At the beginning of the second day after operation, the difference was statistically significant （2-5 day after operation, t=2.24, 2.47, 4.23, 4.92, P=0.02, 0.04, 0.00, 0.00）. And differences were statistically significant between groups on postoperative defecation for the first time（t=2.36, P=0.03）, ICU stay time （t=3.87, P=0.00） , postoperative length of hospital stay （t=2.76, P=0.01）, incidence of IAH （14.28%vs 39.28%,χ2=4.46, P=0.04） and gastrointestinal dysfunction （7.14%vs 28.57%,χ2=4.38, P=0.04）. Conclusion Use of probiotics and lactulose in advanced valvular disease after operation can effectively reduce IAP, improve gastrointestinal functio

关 键 词：腹腔高压/腹腔间隔综合征 心脏瓣膜病 益生菌 乳果糖 

分 类 号：R654.2[医药卫生—外科学]