围手术期使用益生菌对先天性心脏病患儿术后炎症反应的影响  

Effects of probiotics on postoperative inflammatory responses in infants with congenital heart diseases

作　　者：安佳 德钦卓嘎 郁迪 莫绪明[1] An Jia;Deqin Zhuoga;Yu Di;Mo Xuming(Department of Cardiothoracic Surgery,Nanjing Children's Hospital(Teaching Hospital,Nanjing University School of Medicine),Nanjing 210008,China)

机构地区：[1]南京市儿童医院(南京大学医学院教学医院)胸心外科,南京210008

出　　处：《中华小儿外科杂志》2024年第7期606-612,共7页Chinese Journal of Pediatric Surgery

摘　　要：目的探索围手术期使用益生菌对先天性心脏病(congenital heart disease,CHD)患儿术后炎症反应的影响。方法前瞻性分析2020年10月至2021年4月在南京市儿童医院接受手术治疗的60例体重≤10 kg的CHD患儿临床资料,按照治疗期间是否使用双歧杆菌四联活菌分为A、B两组,A组30例接受常规治疗并使用双歧杆菌四联活菌,B组30例接受常规治疗且不使用双歧杆菌四联活菌。A组益生菌使用方法为1 g/次,每日3次,CHD术前7 d至术后7 d连续使用。检测并比较两组患儿术前(益生菌使用7 d后,t_(1))、术后第1天(t_(2))、术后第3天(t_(3))、术后第7天(t_(4))白细胞计数(white blood cell count,WBC)、降钙素原(procalcitonin,PCT)、C反应蛋白(C-reaction protein,CRP)、白细胞介素(interleukin,IL)-4、IL-6水平。于t_(1)、t_(2)时获取两组患儿血液、痰液细菌培养结果,比较两组患儿手术结束至开始肠内营养的时间、血管活性药物评分(vasoactive-inotropic score,VIS)、心脏重症监护室(cardiac intensive care unit,CICU)停留时间的差异。组间比较采用独立样本t检验、Mann-Whitney U检验或卡方检验。结果两组患儿t_(1)时WBC、PCT、CRP、IL-4、IL-6水平均在正常范围内,且差异无统计学意义(均P>0.05)。与B组相比,t_(2)时A组IL-6水平明显下降[23.86(6.15,42.55)pg/ml比52.98(16.38,62.38)pg/ml,P=0.047],其余时间两组其他炎症指标差异无统计学意义(均P>0.05)。所有患儿血液细菌培养均未检测出阳性细菌;t_(1)时患儿痰液细菌培养结果均呈阴性;t_(2)时19例患儿痰液细菌培养阳性,其中A组6例、B组13例,以革兰阴性菌较为多见。A、B两组患儿术后首次肠内营养时间、VIS及CICU停留时间比较,差异无统计学意义(均P>0.05)。结论在围手术期对体重≤10 kg的CHD患儿使用双歧杆菌四联活菌可降低术后早期IL-6水平,在一定程度上可减弱体内炎症反应。Objective To explore the effects of probiotics on postoperative inflammatory responses in infants with congenital heart diseases(CHD)during perioperative period.Methods From October 2020 to April 2021,prospective analysis was performed for the relevant clinical data of 60 operated CHD infants weighing≤10 kg.Based upon whether or not using probiotics during hospitalization,they were assigned into two groups of A and B.Group A(n=30)received a combined regimen of Bifidobacterium,Lactobacillus,Enterococcus and Bacillus cereus Tablets plus routine therapy.And group B(n=30)had routine therapy alone.Probiotics were administered at_(1)g thrice daily from Day 7 preoperatively to Day 7 postoperatively.The levels of white blood cell(WBC),procalcitonin(PCT),C-reactive protein(CRP),interleukin(IL)-4 and IL-6 were measured at four timepoints:preoperative(t_(1),Day 7 after probiotic dosing),postoperative Day 1(t_(2)),postoperative Day 3(t_(3))and postoperative Day 7(t_(4)).Blood and sputum bacterial cultures were performed at t_(1)and t_(2).Inter-group differences in initial timing of enteral nutrition,vasoactive-inotropic score(VIS)and duration of cardiac intensive care unit(CICU)stay were compared by independent-sample t test,Mann-Whitney U test or Chi-squared test.Results At t_(1),the levels of WBC,PCT,CRP,IL-4 and IL-6 were all within normal ranges in both groups.There were no statistically significant differences(all P>0.05).As compared with group B,IL-6 level declined markedly in group A at t_(2)[23.86(6.15,42.55)pg/ml vs 52.98(16.38,62.38)pg/ml,P=0.047]while other inflammatory parameters showed no significant inter-group differences at other timepoints(all P>0.05).Blood bacterial cultures remained negative at all timepoints.Sputum bacterial cultures were negative at t_(1).Among 19 infants with positive sputum bacterial cultures at t_(2),6 cases in group A and 13 cases in group B were tested positive for gram-negative bacteria.No statistically significant inter-group differences existed initial timing of enteral nutriti

关 键 词：先天性心脏病 围手术期 益生菌 炎性反应 

分 类 号：R726.5[医药卫生—儿科]