益生菌对腹部手术后患者炎症反应及肠黏膜屏障功能的影响观察

Influence of Probiotics on Inflammatory Reaction and Intestinal Mucous Membrane Barrier Function in Patients after Abdominal Operation

目的:探讨口服益生菌对腹部手术后患者炎症反应及肠黏膜屏障功能的影响。方法:腹部手术患者88例随机分为观察组和对照组各44例。两组患者术前术后均予以等氮量、等热量营养、抗菌药物及支持治疗。观察组术后第3天加用双岐三联活菌胶囊630 mg,po,bid,连用7 d。观察两组术前及术后1 d、7 d后炎症介质及肠黏膜屏障功能指标的变化,比较两组全身炎症反应综合征(SIRS)、感染并发症及药品不良反应的发生率。结果:术后1 d,两组血清(IL-6)、超敏C反应蛋白(hs-CRP)、D-乳酸和二胺氧化酶(DAO)水平均较术前明显上升(P<0.01),两组间比较差异无统计学意义(P>0.05);治疗7 d后,两组血清白介素-6(IL-6)、hs-CRP、D-乳酸和DAO水平较术后1 d明显下降(P<0.05或P<0.01),且观察组各项指标下降幅度较对照组更明显(P<0.05)。观察组感染并发症总发生率明显低于对照组(P<0.05),两组SIRS发生率与药品不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:口服益生菌用于腹部手术后患者可进一步降低血清炎症因子水平,保护与修复肠黏膜屏障功能,减少肠道细菌和内毒素的移位,减少感染并发症的发生,且安全性较好。

Objective： To discuss the influence of oral probiotics on inflammatory reaction and intestinal mucous membrane barrier function in the patients after abdominal operation. Methods： Totally 88 cases of patients after abdominal operation were selected and divided into the observation group and the control group at random with 44 cases in each. The patients in the two groups were given equal nitrogen and caloric nutrition, antibiotics and supporting medical treatment before and after the operation. Three days after the operation, the patients in the observation group were additionally given 630mg bifid triple viable capsules per time, twice a day, oral administration with warm boiled water for 7 days. The changes of inflammation mediators and intestinal mucous membrane barrier function indices of the patients in the two groups before the operation and on the first day and 7th day after the treatment were observed, and the occurrence rates of SIRS, infection complications and adverse drug reactions （ADR） were compared as well. Results： The serum IL-6, hs-CRP, D-lactic acid and DAO levels of the patients in the two groups on the first day after the operation were obviously increased compared with those before the operation （P 〈 0.01 ）, and the differences between the two groups were not significant （P 〉 0.05 ）. After the 7-day medical treatment, the serum IL-6, hs-CRP, D- lactic acid and DAO levels of the patients in the two groups were obviously declined compared with those on the first day after the operation （P 〈0.05 or P 〈0.01 ）, and the declining rate in the observation group was much higher than that in the control group （P 〈0.05 ）. There was no statistical difference in the occurrence rate of SIRS between the two groups （P 〉 0.05）. The total occurrence rate of infection complications of the patients in the observation group was much lower than that in the control group （P 〈 0.05）. There was no statistical difference in the ADR and the occurence rate of SIRS. between the two groups （P 〉 0.05）. Conclusion： The relatively obvious inflammatory xeaction and intestinal mucous membrane barrier dysfunction appear in the pa- tients after abdominal operation, and oral probiotics can reduce serum IL-6, hs-CRP, D- lactic acid and DAO levels of the patients after abdominal operation, control inflammatory reaction, protect and remedy intestinal mucous membrane barrier function, reduce translocation of intestinal bacteria and endotoxin and reduce the occurrence of infection complications with promising safety.