腰椎后路手术肠道菌群变化的研究

Study on the changes of intestinal flora associated with the posterior lumbar spine surgery

目的探讨腰椎后路手术患者肠道菌群的变化以期更合理的指导临床治疗。方法选择58例腰椎后路手术患者,出现肠道菌群失调症者38例,未出现肠道菌群失调症的20例作为对照组。在腰椎后路手术后,分别取2组患者自然排出的新鲜粪便10 g,采用定性定量检测比较2组患者肠道主要菌群差异及B/E值。肠道菌群失调症患者且与手术前自然排出的新鲜粪便进行相同比较。结果试验组肠道的双歧杆菌、类杆菌数量及B/E值较对照组均减少,分别是:9.21±0.65 vs 10.12±0.85;10.02±0.45 vs 10.23±0.45;1.05±0.17 vs 6.99±1.24,差异有统计学意义(P<0.05);而肠杆菌、肠球菌数量较对照组增加,分别是:9.11±1.09 vs 8.55±0.89;7.80±1.02vs 7.29±0.98,差异有统计学意义(P<0.05)。小梭菌、乳杆菌与对照组相比较,差异无统计学意义(P>0.05)。肠道菌群失调症患者与手术前进行比较,差异无统计学意义(P>0.05)。结论腰椎后路手术出现肠道菌群失调患者专性厌氧菌减少,条件致病菌增加,肠道微生物定植抗力下降。正确及时地去除病因,尽可能地采取微创手术技术,减少医源性损伤,调整机体免疫功能,纠正营养不良,合理使用抗生素是解决腰椎后路手术患者肠道功能障碍的有效办法。

Objective To explore the change of intestinal flora after posterior lumbar spine surgery for the purpose of guiding clinical treatment. Method Among 58 cases of lumbar spine surgery recipients, 38 who occurred intestinal flora dysfunction were viewed as experimental group, the other 20 patients as the control group. The differences between the intestinal bacteria flora and B/E values of the two groups were compared by qualitative and quantitative detection. The intestinal flora of the patients with intestinal dysbacteriosis were compared with those prior to the surgery. Result The number of intestinal Bifidobacterium, Bacteroides, and B/E values of the dysbacteriosis group and control group were 9.21 ± 0.65 vs 10.12 ± 0.85, 10.02 ± 0.45 vs 10.23 ± 0.45 and 1.05 ± 0. 17 vs 6.99 ± 1.24, respectively, with the differences being statistically significant （P 〈 0.05）. The number of Enterobacter and Enterococcus were 9.11 ± 1.09 vs 8.55 ± 0. 89 and 7.80 ± 1.02 vs 7.29 ± 0.98 respectively, a significant increase in the dysfunctional group （ P 〈 0.05 ）. The number of small clostridium and lactobaciUus showed no significant difference between two groups （ P 〉 0.05）. Compared to the presurgery group, the dysbacteriosis group had no significant difference （P 〉 0.05）. Conclusion Posterior lumbar spine surgery recipients may suffer from intestinal flora dysfunction, with the increasing of opportunistic pathogen and decreased colonized resistance of intestinal microbial flora. Prompt and proper elimination of the cause, reduction of iatrogenic injury, regulattion of the immune function, correction of malnutrition and rational use of antibiotics etc can be effective ways to solve the intestinal flora dysfunction after posterior surgery of lumbar spine.