强化益生菌方案辅助肠内营养治疗重症急性脑梗死的疗效及作用机制探讨  

Clinical Effects and Action Mechanism Investigation of Enteral Nutrition Supplemented with Probiotics Regimen in the Treatment of Patients with Severe Acute Cerebral Infarction

作　　者：周莉[1] 江华[1] 沈流燕 邓楠[1] 曾国利[1] 陈晓飞 杨均[1] ZHOU Li;JIANG Hua;SHEN Liuyan;DENG Nan;ZENG Guoli;CHEN Xiaofei;YANG Jun(Luzhou People′s Hospital,Luzhou 646000,Sichuan,China)

机构地区：[1]泸州市人民医院,四川泸州646000

出　　处：《中西医结合心脑血管病杂志》2020年第22期3752-3755,共4页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：2018年四川省医学会高血压(施慧达)专项课题(No.2018SHD3-7)。

摘　　要：目的探讨强化益生菌方案辅助肠内营养治疗重症急性脑梗死的疗效及作用机制。方法选取我院2017年1月—2019年3月收治的重症急性脑梗死病人124例,以随机抽签法分为对照组(62例)和观察组(62例)。两组均给予肠内营养支持,对照组给予双歧杆菌乳杆菌三联活菌散,观察组在对照组基础上加用蜡样芽孢杆菌活菌辅助治疗。比较两组治疗前后上臂三头肌肌围(MAMC)、白蛋白(ALB)、血红蛋白(Hb)、炎症相关因子、肠道黏膜屏障功能指标及应激反应指标水平。结果观察组治疗后MAMC、ALB及Hb水平均高于对照组与本组治疗前(P<0.05);观察组治疗后肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、同型半胱氨酸(Hcy)及可溶性细胞间黏附分子-1(sICAM-1)水平均低于对照组与本组治疗前(P<0.05);观察组治疗后D-乳酸、二胺氧化酶(DAO)及Cluaudin-4水平均低于对照组与本组治疗前(P<0.05);观察组治疗后皮质醇(Cor)、去甲肾上腺素(NE)、丙二醛(MDA)水平均低于对照组与本组治疗前(P<0.05);观察组治疗后总抗氧化能力明显高于对照组与本组治疗前(P<0.05)。结论强化益生菌方案辅助肠内营养治疗重症急性脑梗死可有效改善机体营养状态,而这一优势可能与其能够有效抑制肠道炎症反应水平、保护肠道黏膜屏障功能及减轻应激反应有关。Objective To investigate the clinical effects and action mechanism of enteral nutrition supplemented with probiotics regimen in the treatment of patients with severe acute cerebral infarction.Methods A total of 124 patients with severe acute cerebral infarction were selected from January 2017 to March 2019 and randomly divided into control group(62 patients)and observation group(62 patients).All patients were given enteral nutritional support.The patients in control group were treated with bifidobacterium triple viable powder,and the patients in observation group were treated with bifidobacterium triple viable powder and bacillus cereus live bacteria.The levels of mid-arm muscle circumference(MAMC),albumin(ALB),hemoglobin(Hb),inflammatory related factors,intestinal mucosal barrier function index and stress response index before and after treatment were compared.Results After treatment,the levels of MAMC,ALB,Hb of observation group were significantly higher than those in control group(P<0.05).The levels of tumor necrosis factor-α(TNF-α),Interleukin-1β(IL-1β),homocysteine(Hcy),and soluble intercellular adhesion molecule-1(sICAM1)of observation group after treatment were significantly higher than those in control group(P<0.05).The levels of D-lactic acid,diamine oxidase(DAO),and Cluaudin-4 of observation group after treatment were significantly lower than those in control group(P<0.05).The levels of norepinephrine(NE),cortisol(Cor),and malondialdehyde(MDA)of observation group after treatment were significantly lower than those in control group(P<0.05).The total antioxidant capacity of observation group after treatment was significantly higher than those in control group(P<0.05).Conclusion Enteral nutrition supplemented with probiotics regimen in the treatment of patients with severe acute cerebral infarction can effectively improve the body nutritional status.This advantage may be closely related to its ability to effectively inhibit intestinal inflammatory response,protect intestinal mucosal barrier function an

关 键 词：急性脑梗死 益生菌 肠内营养 作用机制 炎性因子 应激反应 肠道黏膜屏障功能 

分 类 号：R743[医药卫生—神经病学与精神病学] R255.2[医药卫生—临床医学]