嗜酸乳杆菌联合莫沙必利治疗颅脑损伤术后胃肠功能障碍的临床研究

Clinical effects of Lactobacillus acidophilus combined with mosapride in treatment of gastrointestinal dysfunction after craniocerebral injury

背景重型颅脑损伤后多数患者存在胃肠动力不足现象,当机体受到外界机械创伤时,易引发感染、呕吐、胃内容物反流等现象,使早期胃肠功能出现障碍,影响营养摄入,加重脑水肿,延迟伤口愈合,不利于患者预后.莫沙必利为临床常用促胃肠动力药,可提升胃肠道动力,加快胃排空.同时,嗜酸乳杆菌可调节肠道内菌群,保护肠道黏膜屏障、维持肠道平衡状态、缓解胃动力.本研究旨在探讨嗜酸乳杆菌联合莫沙必利治疗对颅脑损伤术后胃肠功能障碍患者肠内营养达标时间、肠道菌群、康复进程等方面的影响,分析其临床应用效果.目的观察嗜酸乳杆菌联合莫沙必利治疗颅脑损伤术后胃肠功能障碍临床效果.方法选取2018-02/2021-02我院颅脑损伤术后胃肠功能障碍患者92例,以随机数字表法按1:1比例分为研究组、对照组,各46例.常规治疗基础上,对照组予以莫沙必利,研究组予以嗜酸乳杆菌联合莫沙必利,均治疗1 wk.比较两组临床疗效、肠内营养达标时间、康复进程、28 d病死率以及治疗前、治疗3 d、1 wk后胃动力指标[腹内压(intra-abdominal pressure,IAP)、胃残留量(gastric residual volume,GRA)]、肠道屏障功能指标[D-乳酸(D-lactic acid,D-LA)、二胺氧化酶(diamine oxidase,DAO)]水平、肠道菌群(双歧杆菌、乳酸杆菌、肠球菌、肠杆菌)数量.结果研究组总有效率93.48%较对照组78.26%高(P<0.05);研究组肠内营养达标时间、机械通气时间、重症监护病房住院时间较对照组短(P<0.05);两组28 d病死率相比,差异无统计学意义;研究组治疗3 d、1 wk后IAP、GRA及D-LA、DAO水平均低于对照组(P<0.05);研究组治疗3 d、1 wk后双歧杆菌、乳酸杆菌数量均多于对照组,肠球菌、肠杆菌数量均少于对照组(P<0.05).结论嗜酸乳杆菌联合莫沙必利治疗颅脑损伤术后胃肠功能障碍疗效显著,可缩短肠内营养达标时间,调节肠道菌群,保护肠黏膜屏障,促进胃肠道功能恢复,加快患者康复进程.

BACKGROUND Most patients with severe craniocerebral injury have gastrointestinal motility deficiency.When the body is exposed to external mechanical trauma,infection,vomiting,and gastric content reflux tend to occur,which causes early gastrointestinal dysfunction,affects nutrient intake,aggravates brain edema,delays wound healing,and is not conducive to the prognosis of patients.Mosapride is a commonly used gastrointestinal motility agent,which can improve gastrointestinal motility and speed up gastric emptying.Lactobacillus acidophilus can regulate the intestinal flora,protect the intestinal mucosal barrier,maintain intestinal balance,and relieve gastric motility.The purpose of this study was to investigate the effects of Lactobacillus acidophilus combined with mosapride treatment on the time to reach enteral nutrition standards,intestinal flora,rehabilitation process,and other aspects of patients with gastrointestinal dysfunction after craniocerebral injury,and to evaluate its clinical effects.AIM To observe the clinical effects of Lactobacillus acidophilus combined with mosapride in the treatment of gastrointestinal dysfunction after craniocerebral injury.METHODS A total of 92 patients with gastrointestinal dysfunction after craniocerebral injury at our hospital from February 2018 to February 2021 were selected and divided into a study group and a control group at a ratio of 1:1 using a random number table,with 46 cases in each group.On the basis of conventional treatment,the control group was given mosapride,and the study group was given Lactobacillus acidophilus combined with mosapride for 1 wk.The clinical efficacy,time to reach enteral nutrition standards,recovery progress,28-d mortality rate,gastric motility indexes[intra-abdominal pressure(IAP)and residual gastric volume(GRA)],and intestinal motility before treatment and after 3 d and 1 wk of treatment were compared between the two groups.Intestinal barrier function indexes[D-lactic acid(D-LA)and diamine oxidase(DAO)]and intestinal flora(Bifidobacterium,Lactobacillus,Enterococcus,and Enterobacter)were also compared.RESULTS The total effective rate of the study group was higher than that of the control group(93.48%vs 78.26%,P<0.05).The time to reach enteral nutrition standards,time to mechanical ventilation,and the length of ICU stay in the study group were shorter than those of the control group(P<0.05).There was no significant difference in the 28-d mortality rate between the two groups(P>0.05).The APACHE II and SOFA scores of the study group were lower than those of the control group after 3 d and 1 wk of treatment,and the Glasgow Coma scale scores were higher than those of the control group(P<0.05).The levels of IAP,GRA,D-LA,and DAO in the study group were lower than those of the control group after 3 d and 1 wk of treatment(P<0.05).The numbers of Bifidobacterium and Lactobacillus in the study group were more than those of the control group after 3 d and 1 wk of treatment,and the numbers of Enterococcus and Enterobacter were less than those of the control group(P<0.05).CONCLUSION Lactobacillus acidophilus and mosapride are effective in treating gastrointestinal dysfunction after craniocerebral injury.They can shorten the time to reach enteral nutrition standards,adjust the intestinal flora,protect the intestinal mucosal barrier,promote the recovery of the gastrointestinal tract and nerve function,and accelerate the recovery process of patients.