双歧杆菌对新生儿呼吸机相关肺炎肠源性致病菌的影响

Influence of bifidobacterium on the enterogenous pathogen of ventilator associated pneumonia in neonates

目的探讨给机械通气新生儿补充双歧杆菌是否能有效控制呼吸机相关性肺炎(VAP)肠源性感染。方法将机械通气新生儿随机分两组,观察组鼻饲双歧杆菌,对照组不干预,观察两组发生VAP的情况、胃液pH、胃细菌定植、病原菌分布、病原菌与胃定植细菌的同源性等。结果观察组VAP发生率显著低于对照组,分别为13.16%和46.51%(P<0.01)。机械通气第3天、第5天、第7天观察组pH≤3的比率均高与对照组(P<0.01);第5天及第7天观察组胃细菌定植比率均低于对照组(P<0.01);观察组病原菌与胃定植菌同源比率低于对照组(P<0.01),均具统计学意义。结论双歧杆菌可降低胃液pH,减少胃内细菌定值,抑制肠道细菌经胃-咽-下呼吸道的移位而减少新生儿肠源性VAP。

Objective To investigate whether Bifidobacterium was effective in reducing the incidence of ventilator-asso- ciated pneumonia （VAP） caused by enterogenous pathogens. Method The neonates given mechanical ventilation were ran-domly divided into two groups. The experimental group was given bifidobacteria by nasal feeding, while the control group was not intervened. The two groups were observed respectively for VAP incidence, gastric Juice pH, gastric bacterial colonization, pathogen distribution and the homology between the gastric colonized bacteria and the pathogen. Result The VAP incidences of experimental group and the control group were 15.15 % and 46.51% respectively （P 〈 0.01 ）. The ratio of gastric juice pH ≤3 were higher in experimental group than in control group at the third, fifth and seventh day （ P 〈 0.01 ）. The colonization ratio of gastric bacteria in experimental group were lower than that in control group at the fifth and seventh day （P 〈 0.01 ）. There were statistically significant difference between two groups. The homology ratio between the pathogen and colonized bacteria was lower in experimental group than in control group （P 〈 0.01）. Conclusion Bifidobacterium can reduce gastric juice pH and colonization of bacteria in stomach, inhibit displacement of intestinal bacteria from stomach through oropbarynx to lower respiratory tract, and reduce the incidence of neonatal enterogenous VAP.