肠内营养联合合生元制剂预防危重症病人呼吸机相关肺炎的前瞻性随机对照研究

Effect of enteral nutrition combined with synbiotics on ventilator-associated pneumonia in critically ill patients:a prospective randomized controlled study

目的:观察肠内营养联合合生元制剂对危重症病人呼吸机相关性肺炎(VAP)的预防效果。方法:本试验为前瞻、随机、对照、单盲研究,将符合入组条件的行机械通气的病人共121 例纳入研究,共计86 例病人完成试验,其中试验组45 例,对照组41 例。对照组给予均衡营养素,试验组在给予均衡营养素的基础上,另外添加经肠内补充益生菌与益生元联用的合生元制剂。比较两组病人VAP的发生率及营养指标、抗生素使用、ICU住院天数、机械通气时间等。结果:对照组与试验组VAP的发生率分别为56.1%和37.8%,试验组明显低于对照组,差异有统计学意义(P<0.05);前白蛋白、转铁蛋白及视黄醇结合蛋白在两组均有明显升高,但组间差异不显著;试验组的抗生素使用、ICU住院天数、机械通气时间明显缩短,差异有统计学意义(P<0.05)。结论:肠内营养联合合生元制剂能够显著降低危重症病人VAP的发生率,并能够改善病人的营养状况,减少机械通气时间、ICU住院天数和抗生素使用,具有临床推广使用的价值。

Objective: To observe the preventive effect of enteral nutrition combined with synbiotics on ventilator-associated pneumonia (VAP) in critically ill patients. Methods: This was a prospective, randomized, controlled and single blind study. 121 patients with mechanical ventilation were included in the study, of which 86 patients completed the experiment, including 45 cases in the experiment group and 41 cases in the control group. In the control group, the balanced nutrients were given, while the synbiotics (mixture of probiotics and prebiotics) were supplemented by enteral supplementation in the experiment group. The incidence of VAP and the nutritional index, the use of antibiotics, the days of hospitalization in ICU and the time of mechanical ventilation were recorded. Results:The incidence rate of VAP was 56.1% and 37.8% in the control group and in the experimental groups, respectively(P<0.05). The prealbumin, transferrin and retinol-binding protein in both groups were significantly elevated, but the difference between groups was not significant. The use of antibiotics, ICU hospitalization days and mechanical ventilation time of ICU were significantly reduced(P<0.05). Conclusion: Enteral nutrition combined with synbiotics may reduce the incidence of ventilator-associated pneumonia in critically ill patients, and could improve the nutritional status, reduce mechanical ventilation time, ICU hospitalization days and antibiotic use.