危重症患者肠道微生态失衡与凝血系统功能紊乱的交互作用及肠道微生态调整的改善作用  

Interaction between intestinal microecological imbalance and coagulation system dysfunction in critically ill patients and improvement of intestinal microecological adjustment

作　　者：肖玲[1] 文海燕[1] 许伟恒 肖凤仙[2] 高红雨[3] 茆成祥 XIAO Ling;WEN Hai-yan;XU Wei-heng;XIAO Feng-xian;GAO Hong-yu;MAO Cheng-xiang(Department of Intensive Care Unit,Baoding Second Central Hospital,Baoding 072750;Department of Clinical Nutrition,Baoding Second Central Hospital,Baoding 072750;Department of Cardiology,Baoding NO.1 Hospital;Department of General Surgery,Army 82nd Group Army Hospital General Surgery,Baoding 071000,Hebei,China)

机构地区：[1]保定市第二中心医院重症医学科,河北保定072750 [2]保定市第二中心医院临床营养科,河北保定072750 [3]保定市第一医院心内科 [4]陆军第八十二集团军医院普外科,河北保定071000

出　　处：《川北医学院学报》2023年第1期45-49,共5页Journal of North Sichuan Medical College

基　　金：河北省重点研发计划自筹项目(182777239)。

摘　　要：目的:探讨危重症患者肠道微生态失衡与凝血系统功能紊乱的交互作用及肠道微生态调整的改善作用。方法:选取80例危重症患者依据治疗方式不同分为观察组和对照组,每组各40例。对照组给予常规支持性治疗;观察组在对照组基础上给予微生态治疗。依据急性生理与慢性健康(APACHEⅡ)评分将患者进行危重症分级,并检测肠道菌群(双歧杆菌、乳酸杆菌和肠球菌)、凝血功能(APTT、Fib、D-D)及肠道屏障功能(NO、DAO、D-乳酸)水平,分析危重症患者肠道微生态失衡与凝血系统功能紊乱的交互作用及微生态制剂的治疗效果。结果:低危组、中危组、高危组患者肠道菌群指标、凝血功能指标和肠道屏障功能指标比较,差异具有统计学意义(P<0.05);进一步组间两两比较显示,肠道菌群双歧杆菌和乳酸杆菌、肠道屏障功能NO水平比较:低危组>中危组>高危组,肠道菌群肠球菌、凝血功能APT、Fib和D-D、肠道屏障功能DAO和D-乳酸水平比较:低危组<中危组<高危组,组间两两比较,差异具有统计学意义(P<0.05);危重症患者APACHEⅡ评分与肠道菌群肠球菌、凝血功能(APTT、Fib、D-D)水平、肠道屏障功能(DAO、D-乳酸)指标呈正相关(P<0.05),与肠道菌群双歧杆菌和乳酸杆菌、肠道屏障功能NO水平呈负相关(P<0.05);肠道双歧杆菌水平、乳酸杆菌均与凝血功能(APTT、Fib、D-D)水平、肠道屏障功能(DAO、D-乳酸)呈负相关(P<0.05),与肠道屏障功能NO水平呈正相关(P<0.05);肠道肠球菌水平与凝血功能(APTT、Fib、D-D)水平、肠道屏障功能(DAO、D-乳酸)呈正相关(P<0.05),与肠道屏障功能NO水平呈负相关(P<0.05);两组治疗前肠道菌群、凝血功能指标及肠道屏障功能指标比较,差异无统计学意义(P>0.05),治疗后均得到改善(P<0.05),且治疗后观察组各指标均优于对照组(P<0.05)。观察组不良反应率(7.5%)低于对照组(25.0%)(P<0.05)。两组死亡率差异�Objective:To study the interaction between intestinal microecological imbalance and coagulation system dysfunction in critically ill patients and the improvement effect of intestinal microecological adjustment.Methods:80 critically ill patients were divided into observation group and control group according to treatment methods, the control group was treated with conventional supportive treatment, with 40 cases in each group.the observation group was treated with microecological treatment on the basis of the control group.To grade the critical illness on the basis of acute physiology and chronic health(APACHE II) score, and test the intestinal flora(Bifidobacterium, Lactobacillus and Enterococcus),coagulation function(APTT,Fib, D-D) and intestinal barrier function(NO,DAO,D-lactic acid),and analyze the interaction between intestinal microecological imbalance and coagulation system dysfunction in critically ill patients and the therapeutic effect of microecological preparations.Results:There were statistically significant differences in intestinal flora indexes, coagulation function indexes and intestinal barrier function indexes in low-risk group, medium-risk group and high-risk group(P<0.05).Further pin-to-pair comparison between groups showed that NO levels of intestinal flora bifidobacterium and Lactobacillus and intestinal barrier function were as follows: low-risk group>medium-risk group>high-risk group, Intestinal flora enterococcus, clotting function APT,Fib and D-D,intestinal barrier function DAO and D-lactic acid: Low risk group(P<0.05),but they were improved after treatment(P<0.05),and all indexes in the observation group were better than those in the control group after treatment(P<0.05).The adverse reaction rate of observation group(7.5%) was lower than that of control group(25.0%)(P<0.05).There was no significant difference in mortality between the two groups(P>0.05).Conclusion:There is a significant correlation between intestinal microecological imbalance and coagulation system dysfunction in critica

关 键 词：危重症 肠道微生态 凝血功能 肠黏膜屏障功能 

分 类 号：R446.1[医药卫生—诊断学] R459.7[医药卫生—临床医学]