改善型微生态制剂对ICU危重症患者炎症反应、肠道功能的改善作用

Improvement effect of improved probiotics on inflammatory response and intestinal function in critically ill patients in ICU

目的 探讨重症监护室(ICU)患者采用改善型微生态制剂辅助治疗对于患者炎症反应状态、肠道功能改善的价值。方法 采用前瞻性随机研究,选取2019年6月至2021年12月保定市第二中心医院ICU收治因脑卒中入住的患者80例,采用随机数字表法将其分为两组,每组各40例。两组患者均给予基础治疗措施+早期肠内营养治疗,研究组患者在上述治疗基础上同时采用含有水溶性膳食纤维的微生态制剂治疗。比较两组肠黏膜功能指标[内毒素、D-乳酸、二胺氧化酶(DAO)、尿乳果糖/甘露醇(L/M)]、血清炎症因子[白细胞介素(IL)-6、IL-10、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]、免疫功能指标、肠道菌群变化和患者救治成功率。结果 治疗前,两组的血清内毒素、D-乳酸、DAO、L/M的水平比较,差异均无统计学意义(P> 0.05);治疗2周后,研究组的血清内毒素、DAO、L/M的水平为(41.84±6.69) FU/mL、(8.49±2.38) U/L、0.18±0.05,低于对照组[(45.57±7.20) FU/mL、(10.26±2.89) U/L、0.22±0.06],差异均有统计学意义(P <0.05)。治疗前,两组的血清IL-6、IL-10、TNF-α、CRP水平比较,差异均无统计学意义(P> 0.05);治疗2周后,研究组的血清IL-10、TNF-α水平为(32.64±6.85) ng/mL、(8.39±2.76)mg/L,均低于对照组[(35.80±6.45) ng/mL、(9.44±3.15) mg/L],差异均有统计学意义(P <0.05)。治疗前,两组的外周血CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)比较,差异无统计学意义(P> 0.05);治疗2周后,研究组的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)为(61.77±3.00)%、(41.64±3.30)%、1.68±0.21,高于对照组[(59.26±3.75)%、(39.32±3.56)%、1.56±0.24],差异均有统计学意义(P <0.05)。治疗前,两组肠道菌群比较,差异无统计学意义(P> 0.05);治疗2周后,研究组的肠道双歧杆菌、乳酸杆菌、肠球菌均为(11.63±2.10)、(10.34±1.83)、(11.74±2.01) IgCFU/g,高于对照组[(10.20±1.86)、(9.40±1.78)、(10.52±1.96) IgCFU/g],差异均有统计学意义(P <0.05)。经过4周的住院治疗,研究组治愈出院率为95.00%,与对照组的87.50%比较,差异无统计学意义(P> 0.05)。结论 ICU患者采用改善型微生态制剂辅助治疗有利于减轻患者的炎症反应状态,改善肠道屏障功能,提升患者的免疫水平。

Objective To explore the value of adjuvant therapy with improved probiotics in intensive care unit(ICU)patients on the improvement of inflammatory response state and intestinal function.Methods In this study,a prospective randomized study plan was adopted.A total of 80 patients admitted to the ICU of Baoding Second Central Hospital due to stroke from June 2019 to December 2021 were selected.They were divided into a study group and a control group with 40 cases in each group using a random number table.The patients in the group were all given basic treatment measures+early enteral nutrition therapy.On the basis of the above treatment,the patients in the research group were also treated with probiotics containing water-soluble dietary fiber.The intestinal mucosal function indexes[endotoxin,D-lactic acid,diamine oxidase(DAO),Lactulose/Mannitol(L/M)],serum inflammatory factors[interleukin(IL)-6,IL-10,tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)],immune function indicators,changes in intestinal flora,and success rate of patient treatment were compared between the two groups.Results Before treatment,there was no significant difference in the levels of serum endotoxin,D-lactic acid,DAO and L/M between the study group and the control group(P>0.05);after 2 weeks of treatment,the levels of serum endotoxin,DAO and L/M in the study group were(41.84±6.69)FU/mL,(8.49±2.38)U/L,0.18±0.05,which were lower than those in the control group[(45.57±7.20)FU/mL,(10.26±2.89)U/L,0.22±0.06],the differences were statistically significant(P<0.05).Before treatment,there was no significant difference in serum IL-6,IL-10,TNF-αand CRP levels between the two groups(P>0.05);the levels of IL-6,IL-10,TNF-αand CRP in the study group were(32.64±6.85)ng/mL,(8.39±2.76)mg/L,which were lower than those in the control group[(35.80±6.45)ng/mL,(9.44±3.15)mg/L],and the differences were statistically significant(P<0.05).Before treatment,there was no significant difference in peripheral blood CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)between the two groups(P>0.05);after 2 weeks of treatment,the CD3^(+),CD4^(+),CD4^(+)/CD8^(+)in the study group were(61.77±3.00)%,(41.64±3.30)%,1.68±0.21,which were higher than those in the control group[(59.26±3.75)%,(39.32±3.56)%,1.56±0.24],the difference was statistically significant(P<0.05).Before treatment,there was no significant difference in intestinal flora between the two groups(P>0.05);after 2 weeks of treatment,the Intestinal Bifidobacterium,Lactobacillus,Enterococcus in the study group were(11.63±2.10),(10.34±1.83),(11.74±2.01)IgCFU/g,which were higher than those in the control group[(10.20±1.86),(9.40±1.78),(10.52±1.96)IgCFU/g],the differences were statistically significant(P<0.05).After 4 weeks of hospitalization,compared with 87.50%of the control group,the cured and discharged rate of the study group was 95.00%,and the difference was not statistically significant(P>0.05).Conclusion Adjuvant treatment of ICU patients with improved probiotics is beneficial to reduce the inflammatory response state,improve the intestinal barrier function,and enhance the immune level of patients.