益生菌预防老年消化道术后肠内营养相关性腹泻临床护理研究

Effects of Probiotics on Preventing Diarrhea during Enteral Nutrition after Surgery of Digestive Tract in Elderly Patients

目的观察添加益生菌对老年消化道手术术后肠内营养（EN）相关性腹泻的预防作用。方法将入选的170例术后经鼻饲行EN支持的食管癌或胃癌患者随机分为治疗组和对照组，每组85例，两组术后均给予EN支持并常规护理，治疗组加用双歧杆菌乳杆菌三联活菌片，每次3g，每日3次，鼻饲第7d测定外周血炎性介质、免疫球蛋白、T细胞亚群变化，记录鼻饲期间腹泻、腹胀等消化道不良反应发生率。结果鼻饲7d后，治疗组肿瘤坏死因子α（58．5±14．3 vs 73．3±18．4）pg／ml、C反应蛋白（13．6±4．0vsl7．8±4．6）mg／L显著低于对照组（P〈0．05）；治疗组T细胞亚群CD4＋／CD8＋比值（1．59±0．37vs1．52±0．31）显著高于对照组（P〈0．05），两组免疫球蛋白IgA、IgG、IgM比较差异无统计学意义（P〉0．05）；治疗组鼻饲时间（10．4±1．9 vs 11．2±2．3）d显著低于对照组（P〈0．05）；鼻饲期间治疗组腹泻（5．9％vs17．6％）、腹胀（7．1％vs20．0％）、便秘（1．2％vs 8．2％）发生率均显著低于对照组（P〈0．05）。结论消化道术后EN老年患者添加益生菌有助于预防腹泻等消化道并发症的发生；规范护理操作对减少EN相关性腹泻亦具有重要意义。

Objective To explore the efficacy of probiotics in prevention of elderly enteral nutrition （ EN ） associated diarrhea after digestive tract surgery. Methods 170 postoperative patients supported by nasal feeding ＇after surgery of esophageal or gastric cancer were selected. They were randomly divided into the treatment group and the control group. Two groups were given EN support and routine nursing. The treatment group was added with live combined bifidobacterium and lactobacillus tablets. On day 7 of nasal feeding, inflammatory mediators, immunoglobulin and T cell subsets in peripheral blood were measured. Diarrhea, abdominal distension and other adverse reactions were noted during nasal feeding. Results The levels of TNF -α and CRP in the treatment group were significantly lower than those in the control group （P 〈 0. 05 ）. The ratio of CD4＋/CD8＋ in the treatment group was significantly higher than that in the control group （P 〈 0. 05）. There were no significant differences between the two groups in the levels of lgA, IgG and IgM （P 〉 0. 05）. Feeding time in treatment group was significantly shorten than that in the control group （P 〈 0. 05）. The incidences of diarrhea, abdominal distension and constipation in the treatment group were significantly lower than those in the control group （P 〈 0. 05 ）. Conclusion Probiotics can prevent diarrhea and other gastrointestinal complications in EN support patients. Standardized nursing procedure may contribute to reduce the incidence of EN - associated diarrhea.