益生菌肠内营养对重型颅脑损伤患者呼吸机相关性肺炎的影响  

Effects of Probiotics Enteral Nutrition on Ventilator Associated Pneumonia in Patients with Severe Brain Injury

作　　者：林泽西 林荔青[1] 王剑刃[1] 谢涛 傅西安[1] 浦军 LIN Ze-xi;LIN Li-qing;WANG Jian-ren;XIE Tao;FU Xi-an;PU Jun(Dept.of Neurosurgery,Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou Jiangsu 215008;Dept.of Neurosurgery,The 2nd Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650101,China)

机构地区：[1]南京医科大学附属苏州医院神经外科,江苏苏州215008 [2]昆明医科大学第二附属医院神经外科,云南昆明650101

出　　处：《昆明医科大学学报》2021年第12期17-22,共6页Journal of Kunming Medical University

基　　金：国家自然科学基金资助项目(82160512);苏州市临床重点病种诊疗技术专项基金资助项目(CZX201913)。

摘　　要：目的探讨益生菌联合早期肠内营养在重型颅脑损伤患者呼吸机相关性肺炎(ventilator associated pneumonia,VAP)治疗中的作用,以及对肠粘膜屏障功能的影响。方法选取2016年9月至2020年11月收住南京医科大学附属苏州医院神经外科的重型颅脑损伤患者84例,随机分为观察组和对照组。2组患者均采用鼻饲早期肠内营养,观察组在此基础上增加益生菌治疗。对比2组患者治疗前后的呼吸机相关性肺炎发生率、肠粘膜屏障功能及胃肠道并发症情况。结果与对照组相比,观察组VAP发生率低于对照组,在肠内营养开始后第7、21天超敏C反应蛋白、降钙素原水平显著低于对照组,第7天血浆D-乳酸和二胺氧化酶浓度显著低于对照组,治疗过程中胃肠道并发症显著低于对照组,差异均有统计学意义(P<0.05)。结论益生菌联合早期肠内营养治疗,有助于降低VAP发生率,减少炎症因子释放,保护肠粘膜屏障功能,减少胃肠道并发症。Objective To investigate the effect of probiotics combined with early enteral nutrition in the treatment of severe brain injury patients with VAP and the effect of intestinal mucosal barrier function.Methods A total of 84 patients with severe brain injury admitted to the Neurosurgery Department of Suzhou Hospital affiliated to Nanjing Medical University from September 2016 to November 2020 were randomly divided into observation group and control group.Both groups received early enteral nutrition with nasal feeding,and the observation group received additional probiotics on this basis.The incidence of ventilator-associated pneumonia,intestinal mucosal barrier function and gastrointestinal complications were compared between the two groups before and after treatment.Results Compared with the control group,the incidence of VAP in the observation group is lower,the levels of hypersensitive C-reactive protein and procalcitonin were significantly lower at 7th and 21st days after enteral nutrition,plasma D-lactic acid and diamine oxidase concentrations were significantly lower at 7th day after enteral nutrition.Gastrointestinal complications during treatment were significantly lower than those in the control group.And the differences were statistically significant(P<0.05).Conclusion Probiotics combined with early enteral nutrition can reduce the incidence of VAP,reduce the release of inflammatory factors,protect the intestinal mucosal barrier function,and reduce gastrointestinal complications.

关 键 词：益生菌 重型颅脑损伤 呼吸机相关性肺炎 肠黏膜屏障 肠内营养 

分 类 号：R651.1[医药卫生—外科学] R459.3[医药卫生—临床医学]