益生菌预防新生儿呼吸机相关性肺炎的临床疗效研究

A clinical efficacy study of probiotics on preventing ventilator-associated pneumonia in neonates

目的探讨阻断新生儿呼吸机相关性肺炎（ventilatorassociatedpneumonia，VAP）胃-肺感染途径的方法，降低VAP发生率。方法将机械通气的80例新生儿分为2组，治疗组（40例）鼻饲益生菌（双歧杆菌），对照组（40例）不干预。观察2组患儿VAP发生率、胃液pH值、胃细菌定植及其与VAP病原学的同源性。结果治疗组和对照组患儿VAP发生率分别为12．5％（5／40）和47．5％（19／40），两组比较差异有统计学意义（x2=10．21，P〈0．01）；治疗组患儿VAP发生时间[（5．4±2．1）d]明显晚于对照组[（4．3±1．0）d]（t=3．2，P〈0．01）。治疗组患儿予机械通气第7天胃液pH值≤3的比率（80．0％，32／40）明显高于对照组（47．5％，19／40）（x2=11．5，P〈0．01）；而胃细菌定植率（30．0％，12／40）明显低于对照组（80．0％，32／40）（x2=16．9，P〈0．01）；治疗组VAP病原菌与胃定植菌同源率（40．0％，2／5）明显低于对照组（78．9％，15／19）（X2=8．7，P〈0．01）。结论肠道益生菌能降低新生儿胃液pH值，抑制胃内细菌定植，延迟VAP发生时间，降低VAP发生率。

Objective To explore the method that can block the infection route from stomach to lung so as to reduce the incidence of ventilator-associated pneumonia （VAP） in neonates. Methods Neonates with mechanical ventilation were randomly divided into two groups, the treatment group （40 cases） were given probiotics （Bifidobacteria） by nasogastric feeding, control group （40 cases） were given nothing. Prospec- tive survey was performed on the incidence of VAP, gastric juice pH, gastric bacterial colonization, the ho- mology between gastric bacterial colonization and VAP pathogen. Results The VAP incidence of treatment group and control group was 12.5 % （ 5/40 ） and 47.5 % （ 19/40 ） respectively, there was significant differ- ence between the two groups（ x2 = 10. 21 ,P 〈 0. 01 ）. The onset time of VAP in treatment group[ （5.4 ±2. 1 ） d] was later than that of control group[ （4. 3 ± 1.0） d] （ t = 3.2,P 〈 0. 01 ）. The ratio of treatment group that gastric juice dropped to pH ≤3 （80. 0% ,32/40） was higher than that of control group（47.5%, 19/40） （ x2 = 11.5, P 〈 0. 01 ） ; and the ratio of gastric bacterial colonization in treatment group （30.0%, 12/40） was lower than that in control group（ 80. 0%, 32/40） （x2 = 16. 9, P 〈 0. 01 ）. The homology ratio between VAP pathogen and colonization bacteria in treatment group （ 40. 0%, 2/5 ） was lower than that in control group（78.9% ,15/19） （ X2 = 8. 7 ,P 〈0. 01 ）. Conclusion Probiotics can reduce gastric juice pH of neonates and inhibit gastric bacterial colonization. The onset time of VAP can be delayed, the incidence of VAP can be reduced effectively.