益生菌制剂对儿科重症监护病房患儿呼吸机相关性肺炎的预防作用

Prophylactic Effect of Probiotics on Ventilator-Associated Pneumonia in Children in PICU

目的:探讨早期应用益生菌制剂对儿科重症监护病房患儿呼吸机相关性肺炎(ventilator associated pneumonia,VAP)的预防作用。方法:选取2014年10月至2018年10月郑州大学附属儿童医院儿科重症监护病房(pediatric intensive care unit,PICU)行机械通气(mechanical ventilation,MV)治疗的重症患儿120例,采用随机数字表法分为对照组和观察组,每组60例。对照组患儿行常规治疗;观察组患儿在常规治疗的基础上,于MV早期加用双歧杆菌乳杆菌三联活菌片鼻饲治疗。比较两组患儿MV时间、PICU入住时间、VAP发病和病死率,VAP患儿体内肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)和C反应蛋白(CRP)等炎性因子水平的差异。结果:观察组患儿MV时间、PICU入住时间明显短于对照组,VAP发病率明显低于对照组,差异均有统计学意义(P<0.05);两组VAP患儿病死率的差异无统计学意义(P>0.05)。治疗后,观察组VAP患儿IL-6水平明显低于对照组,差异有统计学意义(P<0.05);两组患儿TNF-α、CRP水平的差异均无统计学意义(P>0.05)。结论:益生菌制剂对PICU患儿VAP的发生有预防作用,可缩短患儿MV时间及PICU入住时间,但对VAP患儿体内炎性因子水平及VAP死亡率的影响有待进一步研究。

OBJECTIVE: To probe into the prophylactic effect of probiotics on ventilator-associated pneumonia(VAP) in children in pediatric intensive care unit(PICU). METHODS: 120 children undergoing mechanical ventilation(MV) in PICU in Children’s Hospital Affiliated to Zhengzhou University from Oct. 2014 to Oct. 2018 were selected and divided into control group and observation group via random number table, with 60 cases in each group. The control group was given conventional therapy, while the observation group was given Live combined bifidobacterium and lactobacillus tablets for nasal feeding in early stage of MV based on the control group. Differences in duration of MV, length of stay in PCIU, incidence and mortality of VAP, levels of TNF-α, IL-6 and CRP in VAP children were compared. RESULTS: The duration of MV and length of stay in PCIU of observation group were significantly shorter than those of the control group, the incidence of VAP of observation group was significantly lower than that of the control group, with statistically significant differences(P<0.05);there was no statistical significance in difference in mortality between two groups(P>0.05). After treatment, the IL-6 level of observation was significantly lower than that of the control group, with statistically significant difference(P<0.05);there were no statistical significance in differences in TNF-α and CRP levels between two groups(P>0.05). CONCLUSIONS: Probiotics have a prophylactic effect on the occurrence of VAP in children in PICU, which can shorten the duration of MV and PICU stay, but its effects on inflammatory factor levels and VAP mortality still need further study.