不同液体复苏策略对脓毒症患儿肠道菌群及预后的影响  

Effect of different fluid resuscitation strategies on the intestinal flora and prognosis in children with sepsis

作　　者：史海燕[1] 徐梅先[1] 耿文锦[1] 岳燕科 许笑雷 郭莎 刘岩[1] SHI Haiyan;XU Meixian;GENG Wenjin;YUE Yanke;XU Xiaolei;GUO Sha;LIU Yan(Department of Critical Care Medicine,Hebei Children′s Hospital,Shijiazhuang Hebei 050000,China)

机构地区：[1]河北省儿童医院重症医学一科,河北石家庄050000

出　　处：《蚌埠医学院学报》2024年第11期1467-1471,共5页Journal of Bengbu Medical College

基　　金：河北省医学科学研究课题(20190846)。

摘　　要：目的:探讨平衡盐溶液与0.9%氯化钠溶液复苏策略对脓毒症患儿肠道菌群及预后的影响。方法:选择2020年1月至2022年2月PICU的47例脓毒症患儿,随机分为A组22例和B组25例,A组接受标准治疗加0.9%氯化钠溶液复苏,B组接受标准治疗加乳酸林格溶液复苏。收集并比较氧合指数、血清肌酐、尿素、乳酸、炎性细胞因子[白细胞介素(IL)-6、IL-10和肿瘤坏死因子(TNF)-α]、儿童死亡风险(PRISM)Ⅲ评分和28 d死亡率。通过16S rDNA测序分析肠道微生物群的组成。结果:2组患儿28 d死亡率差异无统计学意义(P>0.05)。与0 h相比,A组患儿液体复苏72 h时IL-6和PRISMⅢ降低(P<0.05和P<0.01),其他指标变化均无统计学意义(P>0.05);B组患儿8项指标均有不同程度的改善(P<0.05~P<0.01),且B组改善程度高于A组(P<0.05~P<0.01)。此外,治疗72 h后,B组患儿血清肌酐、血尿素、IL-6、IL-10、TNF-α浓度低于A组(P<0.05)。主坐标分析揭示了2组样本的显著不同聚类;按LDA评分排序物种:A组依次为梭菌目、梭菌属、厚壁菌门、瘤胃球菌科和粪杆菌,B组依次为拟杆菌门、拟杆菌目和厚壁菌门。结论:平衡盐溶液是脓毒症儿童有效的液体复苏策略,其可能通过改变患儿胃肠道内的细菌生态学发挥作用。Objective:To investigate the effects of balanced salt solution and normal saline resuscitation strategies on the intestinal flora and prognosis of children with sepsis.Methods:A total of 47 children with sepsis from the PICU to February 2022 were randomly divided into the group A(22 cases)and group B(25 cases).The group A were treated with standard treatment combined with 0.9%sodium chloride fluid resuscitation,while the group B were treated with standard treatment combined with lactated Ringer′s solution resuscitation.The oxygenation index,serum creatinine,urea,lactate,inflammatory cytokines(IL-6,IL-10 and TNF-α),child mortality riskⅢ(PRISMⅢ)score and 28-day mortality were compared betwteen two groups.The composition of gut microbiota was analyzed by 16S rDNA sequencing.Results:There was no statistcial significance in the 28-day mortality between two groups(P>0.05).Compared with 0 h,the IL-6 and PRISMⅢin group A decreased after 72 h of fluid resuscitation(P<0.05 and P<0.01),and there was no statistical significance in other indexes(P>0.05).The 8 indexes in the group B were improved to varying degrees(P<0.05 to P<0.01),and the improvement degree of which in the group B was higher than that in group A(P<0.05 to P<0.01).After 72 h of treatment,the serum creatinine,blood urea,IL-6,IL-10 and TNF-αconcentrations in the group B were lower than those in group A(P<0.05).The results of principal coordinate analysis revealed significantly different clusters of two groups.According to the LDA score,the species in the group A were Clostridium,Clostridium,Firmicutes,Ruminococcaceae and Faecalis,and the species in the group B were Bacteroidetes,Bacteroidetes and Firmicutes,respectively.Conclusions:Balanced salt is an effective fluid resuscitation strategy in children with sepsis,which may play a role by altering the bacterial ecology in the children′s gastrointestinal tract.

关 键 词：脓毒症 平衡盐溶液 0.9%氯化钠溶液 液体复苏 儿童 肠道菌群 

分 类 号：R631.4[医药卫生—外科学]