肠内微生态营养辅助治疗对重症肺炎患儿菌群失调平衡及炎性因子的影响

Effect of enteral micro-ecological nutritional adjuvant therapy on bacterial flora imbalance and inflammatory factors in children with severe pneumonia

目的研究肠内微生态营养辅助治疗对重症肺炎(SP)患儿菌群失调平衡及炎性因子的影响。方法选取2016年5月至2018年6月该院儿科收治的SP患儿96例,分为辅助治疗组(双歧杆菌三联活菌散+美罗培南治疗)和常规组(美罗培南治疗)各48例,治疗结束后,观察比较两组胸骨凹陷、肺部啰音、呼吸困难、心律异常、发绀消失时间和双歧杆菌、大肠杆菌数变化情况,以及炎性因子水平[白细胞介素-10(IL-10)、肿瘤坏死因-α(TNF-α)、C反应蛋白(CRP)水平、可溶性细胞间黏附因子-1(sICAM-1)]和并发症发生率及病死率。结果辅助治疗组患儿胸骨凹陷、肺部啰音、呼吸困难、心律异常及发绀消失时间短于常规组,差异有统计学意义(P<0.05);治疗前,两组粪便中双歧杆菌、大肠杆菌数、血清IL-10、TNF-α、CRP、sICAM-1水平比较差异无统计学意义(P>0.05);治疗后,辅助治疗组粪便中双歧杆菌数、血清IL-10水平明显高于常规组,粪便中大肠杆菌数、血清TNF-α、CRP、sICAM-1水平明显低于常规组,差异有统计学意义(P<0.05);辅助治疗组总并发症发生率明显低于常规组,差异有统计学意义(P<0.05);两组病死率比较差异无统计学意义(P>0.05)。结论肠内微生态营养辅助治疗SP患儿能有效促进其各项临床症状消失,使患儿肠道菌群恢复平衡状态,减轻其全身性炎性反应,并有助于减少并发症发生,值得临床推广应用。

Objective To investigate the effect of enteral micro-ecological nutritional adjuvant therapy on bacterial flora imbalance and inflammatory factors in children with severe pneumonia(SP).Methods A tatol of 96 SP children in a hospital from May 2016 to June 2018 were enrolled,and divided into two groups,each with 48 cases.The adjuvant treatment group received Bifidobacterium triple viable powder combined with meropenem treatment,and the routine group received meropenem treatment.After treatment,various indexes were compared between groups,including disappearance time of sternal depression,lung rale,dyspnea,abnormal cardiac rhythm and cyanosis,the number of Bifidobacteria and Escherichia coli,inflammatory factors[interleukin-10(IL-10),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),serum soluble intercellular adhesion molecule-1(sICAM-1)],complication rate and mortality rate.Results The disappearance time of sternal depression,lung rale,dyspnea,abnormal cardiac rhythm and cyanosis in the adjuvant treatment group was shorter than that in the routine group,with statistical significance(P<0.05).Before treatment,the Bifidobacteria,Escherichia coli,serum IL-10,TNF-α,CRP and sICAM-1 showed no difference between the two groups(P>0.05).After treatment,the number of Bifidobacteria and the level of serum IL-10 in adjuvant treatment group were significantly higher than those in routine group,while the number of Escherichia coli,the levels of serum TNF-α,CRP and SICAM-1 in stool were significantly lower than those in routine group,with statistical significance(P<0.05).The incidence of total complications in the adjuvant treatment group was significantly lower than that in the routine group,with statistical significance(P<0.05).There was no significant difference in mortality rate between the two groups(P>0.05).Conclusion Application of enteral micro-ecological nutritional adjuvant therapy can effectively promote the disappearance of various clinical symptoms,restore the intestinal flora balance,reduce its systemic inflammatory response for SP children,with fewer complications,which is worthy of promotion.