添加益生菌的早期滋养量肠内营养对重症脑卒中患者呼吸机相关性肺炎的影响
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摘要
目的探讨早期给予添加益生菌的滋养量肠内营养(EN)对重症脑卒中患者呼吸机相关性肺炎(VAP)的影响。方法选择2015年10月1日至2017年10月1日我院神经内科收治的接受鼻饲饮食及机械通气的重症脑卒中患者56例,随机分为对照组和观察组各28例。对照组患者在入院48h内给予早期肠内营养支持治疗,观察组在对照组基础上常规给予双歧杆菌乳杆菌三联活菌片鼻饲,并给予滋养量肠内营养支持治疗(起始量10～20mL鼻饲低速泵入)。比较两组患者治疗后肠内营养达标时间、肠内营养并发症发生率、营养状态指标、炎症因子水平、呼吸机相关性肺炎发生率、脱机成功率及病死率。结果治疗后,观察组患者腹胀、腹泻、应激性高血糖发生率较低,肠内营养达标时间较短。同时观察组患者血清白蛋白、前白蛋白、淋巴细胞计数均高于对照组,血WBC、CRP、PCT水平均低于对照组。观察组患者脱机成功率相对较高,呼吸机相关性肺炎发生率相对较低。观察组患者GCS评分、APACHEⅡ评分及病死率相对较低,但差异均无统计学意义(P>0.05)。结论早期给予添加益生菌的滋养量肠内营养有助于提高患者肠内营养的耐受性,改善患者营养状态,降低炎性因子水平,有助于减少呼吸机相关性肺炎发生率。
Objective To explore the effect of early enteral nutrition supplemented with probiotics on ventilator-associated pneumonia in patients with severe stroke.Methods This study was a prospective study.56 patients with severe stroke who received nasal feeding and mechanical ventilation from October 1,2015 to October 1,2017 in the Neurology Department of our hospital were randomly divided into the control group(n=28 cases)or the observation group(n=28 cases).Both groups were early enteral nutrition within 48 hours after admission.The observation group was additionally given Live Combined Bifidobacterium and Lactobacillus Tablets through nasal feeding combined with nutritional support(starting dose of 10-20 ml nasal feeding with low speed pump).The two groups were compared in terms of time to recovery of normal level of enteral nutrition,the incidence of complications of enteral nutrition,nutritional status indicators,inflammatory factors,the incidence of ventilator-associated pneumonia,the success rate of weaning from ventilator and the fatality rate after the treatment.Results The incidence rates of abdominal distension,diarrhea and stress hyperglycemia in observation group were lower,and the time to recovery of normal level of enteral nutrition was shorter than in the control group.The levels of serum albumin and prealbumin and lymphocyte count in the observation group were higher,while the blood levels of WBC,CRP and PCT were lower than in the control group.The success rate of weaning from ventilator was relatively higher,and the incidence of ventilator-associated pneumonia was relatively lower in observation group.The GCS score,APACHE II score and the fatality rate in the observation group were relatively lower,but not significantly different from those in the control group.Conclusion Early enteral nutrition supplemented with probiotics can increase the tolerance of patients to enteral nutrition,improve the nutritional status of patients,and lower the levels of inflammatory factors.It may help to reduce the incidence of ventilator-associated pneumonia.
Objective To explore the effect of early enteral nutrition supplemented with probiotics on ventilator-associated pneumonia in patients with severe stroke.Methods This study was a prospective study.56 patients with severe stroke who received nasal feeding and mechanical ventilation from October 1,2015 to October 1,2017 in the Neurology Department of our hospital were randomly divided into the control group(n=28 cases)or the observation group(n=28 cases).Both groups were early enteral nutrition within 48 hours after admission.The observation group was additionally given Live Combined Bifidobacterium and Lactobacillus Tablets through nasal feeding combined with nutritional support(starting dose of 10-20 ml nasal feeding with low speed pump).The two groups were compared in terms of time to recovery of normal level of enteral nutrition,the incidence of complications of enteral nutrition,nutritional status indicators,inflammatory factors,the incidence of ventilator-associated pneumonia,the success rate of weaning from ventilator and the fatality rate after the treatment.Results The incidence rates of abdominal distension,diarrhea and stress hyperglycemia in observation group were lower,and the time to recovery of normal level of enteral nutrition was shorter than in the control group.The levels of serum albumin and prealbumin and lymphocyte count in the observation group were higher,while the blood levels of WBC,CRP and PCT were lower than in the control group.The success rate of weaning from ventilator was relatively higher,and the incidence of ventilator-associated pneumonia was relatively lower in observation group.The GCS score,APACHE II score and the fatality rate in the observation group were relatively lower,but not significantly different from those in the control group.Conclusion Early enteral nutrition supplemented with probiotics can increase the tolerance of patients to enteral nutrition,improve the nutritional status of patients,and lower the levels of inflammatory factors.It may help to reduce the incidence of ventilator-associated pneumonia.
引文
[1]JIANG Yangyang,XU Qin,SONG Yanbo.Progress of factors associated with enteral feeding intolerance[J].Parent&Enter Nutrit,2011,18(1):46-49.(in Chinese)蒋洋洋,许勤,宋燕波.肠内营养病人喂养不耐受相关因素的研究进展[J].肠外与肠内营养,2011,18(1):46-49.
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[3]中华内科杂志编委会,中华消化杂志编委会,中华消化内镜杂志编委会.急性非静脉曲张性上消化道出血诊治指南(2009,杭州)[J].中华消化杂志,2009,29(10):682-687.
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[5]中华医学会重症医学分会.呼吸机相关性肺炎诊断、预防和治疗指南(2013年)[J].中华内科杂志,2013,52(6):524-543.
[6]Shimizu K,Ogura H,Asahara T,et al.Gastrointestinal dysmotility is associated with altered gut flora and septic mortality in patients with severe systemic inflammatory response syndrome:A preliminary study[J].Neurogastroenterol Motil,2011,23(4):330-335.
[7]安友仲.补不足损有余无监测慎营养---再谈危重症病人的营养治疗[J].肠外与肠内营养,2017,24(3):129-131.
[8]Wong S,Jamous A,O′Driscoll J,et al.ALactobacillus casei Shirota probiotic drink reduces antibiotic-associated diarrhoea in patients with spinal cord injuries:A randomised controlled trial[J].Br J Nutr,2014,111(4):672-678.
[9]Tabrizi R,Moosazadeh M,Lankarani KB,et al.The effects of synbiotic supplementation on glucose metabolism and lipid profiles in patients with diabetes:A systematic review and meta-analysis of randomized controlled trials[J].Probiotics Antimicrob Proteins,2017,doi:10.1007/s12602-017-9299-1.
[10]XI Fengchan,GENG Yanxia,YU Wenkui,et al.Effects of enteral nutrition on inflammation responses and cellular immune function in critically ill patients with long-term fasting[J].Parent&Enter Nutrit,2013,20(4):212-215.(in Chinese)习丰产,耿艳霞,虞文魁,等.肠内营养对长期禁食危重症病人炎性反应和细胞免疫的影响[J].肠外与肠内营养,2013,20(4):212-215.
[11]黎介寿.肠内营养与肠屏障功能[J].肠外与肠内营养,2016,23(5):257-259.
[12]黎介寿.首选肠内营养的合理性[J].肠外与肠内营养,2013,20(6):321-323.
[13]Shao F,Xu XD.Effect of microbiological and immunological enteral nutrition on intestinal function and immune status in the patients with long-term use of antibiotics[J].Eur Rev Med Pharmacol Sci,2013,17(18):2481-2485.
[14]JIANG Mingming,FANG Qiang,SUN Qin.Influence of early enteral nutrition with added probiotics on serum inflammatory factors and intestinal mucous membrane barrier function of patients with severe brain injury[J].Chin J Microecol,2015,27(10):1177-1180.(in Chinese)姜明明,方强,孙勤.添加益生菌的早期肠内营养对重型颅脑损伤患者血清炎症因子与肠黏膜屏障功能的影响[J].中国微生态学杂志,2015,27(10):1177-1180.
[15]SHEN Tongyi,QIN Huanlong,GAO Zhiguang.Effects of enteral nutrition combined with probiotics on the gut microecology and barrier function of rats with abdominal infection[J].Chin J Gastrointest Surg,2005,8(5):443-446.(in Chinese)沈通一,秦环龙,高志光.益生菌联合肠内营养对腹腔感染大鼠微生态及屏障功能的影响[J].中华胃肠外科杂志,2005,8(5):443-446.
[2]SONG Jinming,SU Zhiguo,MA Min.Analysis of enteral nutrition in hospitalized pharmacy[J].Parent&Enter Nutrit,2011,18(6):355-357.(in Chinese)宋金明,苏治国,马敏.住院药房肠内营养药物的应用情况分析[J].肠外与肠内营养,2011,18(6):355-357.
[3]中华内科杂志编委会,中华消化杂志编委会,中华消化内镜杂志编委会.急性非静脉曲张性上消化道出血诊治指南(2009,杭州)[J].中华消化杂志,2009,29(10):682-687.
[4]McCowen KC,Malhotra A,Bistrian BR.Stress-induced hyperglycemia[J].Crit Care Clin,2001,17(1):107-124.
[5]中华医学会重症医学分会.呼吸机相关性肺炎诊断、预防和治疗指南(2013年)[J].中华内科杂志,2013,52(6):524-543.
[6]Shimizu K,Ogura H,Asahara T,et al.Gastrointestinal dysmotility is associated with altered gut flora and septic mortality in patients with severe systemic inflammatory response syndrome:A preliminary study[J].Neurogastroenterol Motil,2011,23(4):330-335.
[7]安友仲.补不足损有余无监测慎营养---再谈危重症病人的营养治疗[J].肠外与肠内营养,2017,24(3):129-131.
[8]Wong S,Jamous A,O′Driscoll J,et al.ALactobacillus casei Shirota probiotic drink reduces antibiotic-associated diarrhoea in patients with spinal cord injuries:A randomised controlled trial[J].Br J Nutr,2014,111(4):672-678.
[9]Tabrizi R,Moosazadeh M,Lankarani KB,et al.The effects of synbiotic supplementation on glucose metabolism and lipid profiles in patients with diabetes:A systematic review and meta-analysis of randomized controlled trials[J].Probiotics Antimicrob Proteins,2017,doi:10.1007/s12602-017-9299-1.
[10]XI Fengchan,GENG Yanxia,YU Wenkui,et al.Effects of enteral nutrition on inflammation responses and cellular immune function in critically ill patients with long-term fasting[J].Parent&Enter Nutrit,2013,20(4):212-215.(in Chinese)习丰产,耿艳霞,虞文魁,等.肠内营养对长期禁食危重症病人炎性反应和细胞免疫的影响[J].肠外与肠内营养,2013,20(4):212-215.
[11]黎介寿.肠内营养与肠屏障功能[J].肠外与肠内营养,2016,23(5):257-259.
[12]黎介寿.首选肠内营养的合理性[J].肠外与肠内营养,2013,20(6):321-323.
[13]Shao F,Xu XD.Effect of microbiological and immunological enteral nutrition on intestinal function and immune status in the patients with long-term use of antibiotics[J].Eur Rev Med Pharmacol Sci,2013,17(18):2481-2485.
[14]JIANG Mingming,FANG Qiang,SUN Qin.Influence of early enteral nutrition with added probiotics on serum inflammatory factors and intestinal mucous membrane barrier function of patients with severe brain injury[J].Chin J Microecol,2015,27(10):1177-1180.(in Chinese)姜明明,方强,孙勤.添加益生菌的早期肠内营养对重型颅脑损伤患者血清炎症因子与肠黏膜屏障功能的影响[J].中国微生态学杂志,2015,27(10):1177-1180.
[15]SHEN Tongyi,QIN Huanlong,GAO Zhiguang.Effects of enteral nutrition combined with probiotics on the gut microecology and barrier function of rats with abdominal infection[J].Chin J Gastrointest Surg,2005,8(5):443-446.(in Chinese)沈通一,秦环龙,高志光.益生菌联合肠内营养对腹腔感染大鼠微生态及屏障功能的影响[J].中华胃肠外科杂志,2005,8(5):443-446.