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危重症患者肠内营养相关性腹泻与其肠道菌落的关系及其菌群移植的效果分析

The relationship between enteral nutrition-related diarrhea and intestinal flora in critically ill patients and the effect of microflora transplantation
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摘要 目的探讨危重症患者肠内营养相关性腹泻与其肠道菌落的关系及其菌群移植的效果。方法前瞻性研究,连续选取2020年1月至2021年8月台州市中西医结合医院拟行菌群移植的发生肠内营养相关性腹泻的危重症患者60例为研究组,并以无肠内营养相关性腹泻的危重症患者60例为对照组。检测比较两组粪便双歧杆菌、乳酸杆菌、肠球菌、大肠埃希菌等菌落数,通过受试者工作特征(ROC)曲线分析粪便4种肠道菌群菌落数诊断危重症患者无肠内营养相关性腹泻的价值。研究组患者均接受菌群移植治疗,检测比较患者治疗前、治疗后1周和治疗后1个月的腹泻评分、便血评分、部分Mayo评分及欧洲五维健康量表(EQ-5D)以评价治疗效果。采用Pearson线性相关法分析研究组患者基线粪便4种肠道菌群菌落数与其治疗1周和治疗1个月各疗效指标的关系。结果研究组粪便双歧杆菌、乳酸杆菌菌群菌落数低于对照组[(7.12±0.58)×10^(7)cfu/L比(11.85±1.25)×10^(7)cfu/L、(8.78±1.05)×10^(7)cfu/L比(11.25±1.57)×10^(7)cfu/L],而肠球菌、大肠埃希菌菌群菌落数高于对照组[(8.58±0.88)×10^(7)cfu/L比(3.84±0.72)×10^(7)cfu/L、(8.25±0.97)×10^(7)cfu/L比(3.66±0.63)×10^(7)cfu/L],差异有统计学意义(P<0.05)。ROC曲线分析结果显示,粪便双歧杆菌、乳酸杆菌、肠球菌、大肠埃希菌菌群菌落数诊断患者肠内营养相关性腹泻的曲线下面积均>0.7,具有一定诊断价值。研究组治疗后1周和治疗后1个月的腹泻评分、便血评分、部分Mayo评分均低于治疗前[(1.52±0.36)和(1.13±0.24)分比(2.45±0.51)分、(0.95±0.28)和(0.77±0.21)分比(2.39±0.54)分、(4.17±1.24)和(3.26±0.85)分比(7.86±1.82)分],而患者治疗后1周和治疗后1个月EQ-5D评分与治疗前相比较则有所升高[(0.66±0.11)和(0.79±0.13)分比(0.58±0.08)分],差异有统计学意义(P<0.05)。Pearson线性相关分析结果显示,研究组患者基线粪便双歧杆菌、乳酸杆菌、肠球菌、大肠埃希菌等4种肠道菌群菌落数与其治疗后1周和治疗后1个月的腹泻评分、便血评分、部分Mayo评分以及EQ-5D评分均密切相关(P<0.05)。结论危重症患者肠道菌落与其肠内营养相关性腹泻密切相关,且可影响其菌群移植治疗效果和患者的健康状况。 Objective To investigate the relationship between enteral nutrition-related diarrhea and intestinal flora in critically ill patients and the effect of microflora transplantation.Methods A total of 60 critically ill patients with enteral nutrition-related diarrhea who were scheduled to undergo microflora transplantation in Taizhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2020 to August 2021 were prospectively and continuously selected as the research group,and 60 critically ill patients without enteral nutrition-related diarrhea were selected as the control group.The bacterial count of 4 kinds of intestinal flora in the feces including bifidobacterium,lactobacillus,enterococcus,and escherichia coli were detected and compared between the two groups,and the value of the fecal colony numbers of 4 kinds of intestinal flora in diagnosing non-enteral nutrition-related diarrhea in critically ill patients was analyzed by receiver operating characteristic(ROC)curve.All patients in the research group received microflora transplantation,and the diarrhea score,hematochezia score,partial Mayo score and European five-dimension health scale(EQ-5D)were detected and compared before treatment,1 week after treatment and 1 month after treatment to evaluate the treatment effect.The Pearson linear correlation method was used to analyze the relationship between the colony count of 4 kinds of intestinal flora colonies in the feces of the research group at baseline and the therapeutic indexes for 1 week and 1 month after treatment.Results The number of fecal bifidobacterium and lactobacillus colonies in the study group were lower than those in the control group:(7.12±0.58)×10^(7)cfu/L vs.(11.85±1.25)×10^(7)cfu/L,(8.78±1.05)×10^(7)cfu/L vs.(11.25±1.57)×10^(7)cfu/L.The colony number of enterococcus and Escherichia coli were higher than those of control group:(8.58±0.88)×10^(7)cfu/L vs.(3.84±0.72)×10^(7)cfu/L,(8.25±0.97)×10^(7)cfu/L vs.(3.66±0.63)×10^(7)cfu/L.The differences were statistically significant(P<0.05).ROC curve analysis results showed that the area under the curve of fecal bifidobacterium,lactobacillus,enterococcus and escherichia coli colonies in diagnosing patients with enteral nutrition-related diarrhea were all>0.7,which had certain diagnostic value.The diarrhea scores,stool blood scores and some Mayo scores of the study group at 1 week and 1 month after treatment were lower than those before treatment:(1.52±0.36)and(1.13±0.24)points vs.(2.45±0.51)points,(0.95±0.28)and(0.77±0.21)points vs.(2.39±0.54)points,(4.17±1.24)and(3.26±0.85)points vs.(7.86±1.82)points,and the EQ-5D score of patients 1 week and 1 month after treatment was higher than that before treatment:(0.66±0.11)and(0.79±0.13)points vs.(0.58±0.08)points,the difference was statistically significant(P<0.05).Conclusions The intestinal flora of critically ill patients is closely related to enteral nutrition-related diarrhea,and can affect the therapeutic effect of bacterial flora transplantation and the health status of patients.
作者 柳缨 金敏杰 陈卫挺 Liu Ying;Jin Minjie;Chen Weiting(Department of Critical Care Medicine,Taizhou Hospital of Integrated Traditional Chinese and Western Medicine,Taizhou 317523,China;Department of Cardiovascular Medicine,Taizhou Hospital of Integrated Traditional Chinese and Western Medicine,Taizhou 317523,China)
出处 《中国医师进修杂志》 2023年第8期673-678,共6页 Chinese Journal of Postgraduates of Medicine
基金 浙江省医药卫生科技计划项目(2018KY919)。
关键词 肠道营养 腹泻 危重症 肠道菌落 菌群移植 Enteral nutrition Diarrhea Critical illness Intestinal flora Flora transplantation
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