肠内营养联合益生菌对重症脑卒中伴胃肠功能障碍患者肠黏膜屏障的保护作用

Protective effect of probiotics combined with enteral nutrition on intestinal mucosal barrier in patients with severe stroke concomitant with gastrointestinal dysfunction

目的探讨肠内营养联合益生菌对重症脑卒中伴胃肠功能障碍患者肠黏膜屏障的保护作用,为该类患者的治疗提供参考。方法选择2016年1月至2019年7月于我院住院的84例重症脑卒中伴胃肠功能障碍患者为研究对象,根据肠内营养支持时是否添加益生菌将患者分为联用组和单用组,各42例。两组患者均予控制颅内压、营养脑细胞、保护胃黏膜和维持电解质酸碱平衡等常规治疗。单用组患者在常规治疗基础上给予肠内营养支持,联用组患者在单用组治疗基础上联合双歧杆菌活菌胶囊治疗,630 mg/次,2次/d,水化后鼻饲管内注入。两组患者均治疗7 d。比较两组患者治疗前后营养状态指标、肠黏膜屏障指标及胃肠道并发症的变化。结果治疗7 d后,两组患者血清白蛋白、血红蛋白和转铁蛋白水平较治疗前显著下降,且单用组患者下降幅度大于联用组(均P<0.05);两组患者血清二胺氧化酶、降钙素原和D-乳酸水平较治疗前显著下降,且联用组患者下降幅度大于单用组(均P<0.05)。治疗期间,联用组患者胃肠道并发症发生率显著低于单用组(4.76%vs 19.05%,χ2=4.09,P<0.05)。结论肠内营养联合益生菌可改善重症脑卒中伴胃肠功能障碍患者肠黏膜屏障功能,减少胃肠道并发症的发生,提高肠内营养的耐受性,改善患者营养状态。

Objective To explore the protective effect of probiotics combined with enteral nutrition on intestinal mucosal barrier in patients with severe stroke(SS)concomitant with gastrointestinal dysfunction(GD)and provide a reference for the treatment.Methods A total of 84 patients with SS concomitant with GD who were hospitalized in our hospital from January 2016 to July 2019 were selected.According to whether probiotics were added during enteral nutrition,they were divided into combination group or single drug group,with 42 cases in each group.The patients in two groups were given conventional treatments.The patients in single drug group was additionally given enteral nutrition treatment,while the patients in combination group was given 630 mg of viable Bifidobacteria capsules via nasal feeding,bid for 7 days.The nutritional status indicators[serum albumin(Alb),hemoglobin(Hb)and transferrin(TRF)],intestinal mucosal barrier indicators[serum diamine oxidase(DAO),procalcitonin(PCT)]and gastrointestinal complications were compared between two groups before and after treatment.Results After 7 days′treatment,the levels of serum Alb,Hb and TRF in two groups were significantly lower,and the declines were more significant in single drug group than those in combination group(all P<0.05);the levels of serum DAO,PCT and D-lactic acid in two groups were significantly lower,and the decreases in combination group were more significant than those in single drug group(all P<0.05).The incidence of gastrointestinal complications in combination group was significantly lower than that in single drug group(4.76%vs 19.05%,χ2=4.09,P<0.05).Conclusion Probiotics combined with enteral nutrition for patients with severe stroke concomitant with gastrointestinal dysfunction can improve the intestinal mucosal barrier function,reduce the occurrence of gastrointestinal complications,improve the tolerance of enteral nutrition,and thereby improve the patients′nutritional status.