高活菌数益生菌发酵乳联合肠内营养在颅脑损伤术后患者中的效果观察

Effect of high-density probiotic fermented milk combined with enteral nutrition on patients after craniocerebral iujury surgery

目的探讨高活菌数益生菌发酵乳联合肠内营养在颅脑损伤术后患者中的疗效。方法选取2015年4月至2016年3月新疆维吾尔自治区人民医院神经外科监护室(NICU)收治的重症颅脑损伤患者80例,依据随机数字表法分为观察组(高活菌数益生菌发酵乳联合肠内营养支持,43例)和对照组(单纯肠内营养支持,37例)。2组患者术后24 h开始启动肠内营养,观察组每日肠内营养开始0.5 h前,经鼻饲管给予益生菌活菌发酵乳200 ml,4次/d。4周后观察2组患者感染发生情况、抗生素使用频度、感染持续时间,比较2组患者肠内营养支持过程中胃肠道功能情况、达到目标能量需要的时间及NICU的入住时间。结果观察组总体感染和肺部感染发生率均低于对照组[51.2%(22/43)比86.5%(32/37),30.2%(13/43)比56.8%(21/37)](均P<0.05);观察组患者感染持续时间低于对照组,抗生素使用频度低于对照组(均P<0.05);观察组患者在肠内营养支持过程中腹泻、腹胀等胃肠道并发症的发生率均低于对照组[14.0%(6/43)比32.4%(12/37),7.0%(3/43)比27.0%(10/37)],达到肠内营养目标供给量所需的平均时间及转出NICU进入普通病房的时间短于对照组(均P<0.05)。结论增加高活菌数益生菌发酵乳的肠内营养支持方法有助于改善颅脑损伤术后患者的肠道微生态环境,防止细菌移位,能更有效预防和减少感染性并发症的发生,对调节患者术后胃肠道动力、缩短个体达到目标能量及转出NICU的时间有积极作用。

Objective To explore the efficacy of high-density probiotic fermented milk combined with enteral nutrition in patients after craniocerebral injury surgery. Methods Eighty craniocerebral injury patients who were admitted in Neurosurgery Intensive Care Unit（NICU） of People′s Hospital of Xinjiang Uygur Autonomous Region were randomly divided into observation group（43 cases） and control group（37 cases）. All patients had enteral nutrition 24 h after operation, the initial velocity of nutrition pump was 30-50 ml/h and the maximum velocity was 120-150 ml/h. Patients in observation group had nasogastric feeding of probiotic fermented milk 200 ml at 0.5 h before enteral nutrition, 4 times/d. Incidence of infection, frequency of antibiotic drug use and duration of infection were recorded in 4 weeks of treatment. Gastrointestinal adverse reactions were observed during enteral nutrition; the time of enteral nutrition to achieve the goal of individual energy requirement and the length of NICU stay were analyzed. Results Total infection rate and pulmonary infection rate in observation group were significantly lower than those in control group［51.2%（22/43） vs 86.5%（32/37）, 30.2%（13/43） vs 56.8%（21/37）］（P〈0.05）. Duration of infection and frequency of antibiotic drug use in observation group were significantly less than those in control group（P〈0.05）. Incidences of diarrhea and abdominal distension in observation group were significantly lower than those in control group［14.0%（6/43） vs 32.4%（12/37）, 7.0%（3/43） vs 27.0%（10/37）］（P〈0.05）. The time of individual energy requirement and the length of NICU stay in observation group were significantly shorter than those in control group（P＜0.05）. Conclusion Enteral nutrition enriched with probiotic fermented milk can improve intestinal microecological environment and prevent bacterial translocation; it is more effective in reducing infectious complications, regulating gastrointestinal motility, and shortening the time to reach the goal of individual energy requirement and the time of NICU stay.