益生菌对重症患者呼吸机相关性肺炎的预防作用及肠道功能的影响

Effect of probiotics on prevention of ventilator-associated pneumonia and intestinal function in critically ill patients

目的:观察益生菌制剂对重症监护病房(ICU)危重症患者呼吸机相关性肺炎(VAP)的预防效果及肠道功能的影响。方法:本试验为前瞻、随机、对照研究,将符合入组条件的155例患者随机分为对照组和试验组。2组患者给予相同的处理措施,在此基础上,试验组给予连续3周的益生菌(双歧杆菌、乳酸杆菌混合物)补充。比较2组患者VAP的发生率、肠道菌群变化及消化道症状发生率等。结果:共120例患者完成随访,其中对照组58例,试验组62例。试验组VAP的发生率低于对照组(38.7%比62.1%, χ2=6.541, P<0.05)。试验组口咽部及胃部微生物定植的总检出率低于对照组(51.6%比89.7%, χ2=20.052, P<0.05)。腹内压升高、腹泻、肠鸣音减弱或消失的发生率在试验组明显降低( χ2值分别为8.439、10.849、13.327, P值均<0.05)。试验组患者肠道中乳酸杆菌比例升高。试验组机械通气时间和ICU住院时间较对照组明显缩短( t值分别为8.051、6.538, P值均<0.05)。 结论:益生菌制剂能够明显提高患者肠道中乳酸杆菌比例,显著降低ICU危重症患者VAP发生率,并降低胃肠道症状的发生,减少患者机械通气时间和ICU住院时间,具有临床推广使用的价值。

Objective To observe the effect of probiotics on prevention of ventilator-associated pneumonia(VAP)and intestinal function in critically ill patients.Methods In this prospective,randomized,controlled study,155 patients who met the conditions for enrollment were randomly divided into control group and test group.The same treatment was given to all patients,in addition,the patients in test group were given probiotics(Bifidobacterium,Lactobacillus mixture)for three weeks.The incidence of VAP,changes in gut microbiota and incidence of gastrointestinal symptoms were compared between the two groups.Results 120 patients finished the study,including 58 cases in the control group and 62 cases in the test group.The incidence of VAP in the test group was lower than that in the control group(38.7%vs 62.1%,χ2=6.541,P<0.05).The total detection rate of microbial colonization in the oropharynx and stomach of the test group was significantly lower than that of the control group(51.6%vs 89.7%,χ2=20.052,P<0.05).The incidences of increased intra-abdominal pressure,diarrhea,and weakened or disappeared bowel sounds were significantly reduced in the test group(χ2=8.439,10.849,13.327,all P<0.05).The proportion of lactobacillus in the intestinal tract of the test group was significantly increased.The time of mechanical ventilation and length of stay in intensive care unit in the test group were also significantly shortened compared with the control group(t=8.051,6.538,all P<0.05).Conclusions Probiotics preparation can significantly increase the proportion of lactobacillus in the intestinal tract,reduce the incidence of VAP in critically ill patients,reduce the incidence of gastrointestinal symptoms,reduce the time of mechanical ventilation and the length of stay in intensive care unit,then have the value of clinical promotion.