微生态制剂对早产儿肠道细菌定植的影响

Effects of probiotics on intestinal bacterial colonization in premature infants

目的探讨微生态制剂是否可减少早产儿肠道病原菌定植及肠源性感染的发生,为其临床应用提供理论依据。方法将70例早产儿随机分成治疗组和对照组,每组35例。对照组仅常规护理和治疗,治疗组在此基础上于生后24h内口服或经胃管注入酪酸梭菌二联活菌散,250mg/次,2次/d。于入院时、入院后5d、12d及出院前行直肠拭子培养。收集每位早产儿的临床及实验室资料,进行统计学分析。结果治疗组肠道细菌定植率入院后12d及出院前分别为60%和51%,低于对照组的83%和80%,两组比较差异有统计学意义(P<0.05)。两组排在前3位的定植菌均为肺炎克雷伯氏菌、大肠埃希氏菌、屎肠球菌。治疗组发生腹泻7例(20%),对照组16例(46%),两组比较差异有统计学意义(P<0.05);治疗组发生败血症2例(6%),对照组9例(26%),两组比较差异亦有统计学意义(P<0.05)。结论酪酸梭菌二联活菌散可降低早产儿肠道病原菌的定植率,减少早产儿腹泻及败血症的发生。

Objective To study the possible roles of probiotics in decreasing intestinal bacterial colonization rate and the incidence of enterogenic infections in premature infants.Methods Seventy premature infants were randomly assigned to two groups： probiotics and conventional treatment groups （control） （n=35 each）. The probiotics treatment group was administered with oral Clostridium butyricum powder （250 mg, twice daily up to discharge） 24 hrs after birth except conventional treatment. Rectal swab cultures were done at admission, 5 and 12 days after admission, and before discharge. Clinical and laboratory findings were compared between the two groups.Results The intestinal bacterial colonization rate in the probiotics treatment group was lower than that in the control group 12 days after admission （60% vs 83%; P0.05） and before discharge （51% vs 80%; P0.05）. Klebsiella pneumoniae, Escherichia coli and Enterococcus faecium were common colonization bacteria in the two groups. Diarrhea occurred in 7 cases （20%） in the probiotics treatment group compared with 16 cases （46%） in the control group （P0.05）. Two infants （6%） developed sepsis in the probiotics treatment group compared with 9 cases （26%） in the control group （P0.05）.Conclusions Probiotics can decrease intestinal bacterial colonization rate and the incidence of diarrhea and sepsis in premature infants.