作　　者： ; (王敏）;

机构地区： 暨南大学

出　　处： 《新发传染病电子杂志》 2023年第3期29-33,共5页

摘　　要： 目的 观察双歧杆菌三联活菌胶囊联合肠内营养预防脓毒症机械通气患者呼吸机相关性肺炎(VAP)的效果以及对患者营养状态和免疫功能的影响。方法 选取2019年9月至2021年1月入住暨南大学附属广州红十字会医院重症医学科(ICU)的脓毒症机械通气患者共102例,用随机数字法分为C组(50例)和L组(52例),两组患者均于入院后24~72h内留置鼻胃管行肠内营养支持治疗,L组在C组基础上予以双歧杆菌三联活菌胶囊,统计比较两组患者治疗前及治疗14d营养指标[血清总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)、血红蛋白(Hb)]和免疫指标[CD3^(+)T淋巴细胞、CD4^(+)T淋巴细胞、CD4^(+)/CD8^(+)、分泌型免疫球蛋白A(SIgA)],比较治疗后28dVAP、菌血症、病死率、机械通气时间、ICU住院时间情况。结果 治疗后14d,L组血清TP、ALB、PA、Hb水平均高于C组(均P <0.01)。治疗后14d,L组血清CD3^(+)T淋巴细胞、CD4^(+)T淋巴细胞、CD4^(+)/CD8^(+)、SIgA水平均高于C组(均P <0.05)。L组患者的VAP发病率低于C组(χ^(2)=3.922,P=0.048),L组机通气时间、ICU住院时间均短于C组(t分别为2.264、2.054;P分别为0.013、0.021),L组菌血症的发病率、病死率与C组差异无统计学意义(χ^(2)分别为1.230、0.631;P分别为0.267,0.427)。L组胃潴留、腹胀、腹泻、便秘发生率低于C组(χ^(2)分别为5.480、15.291、15.653、7.233,P分别为0.019、<0.001、<0.001、0.007)。结论 双歧杆菌三联活菌胶囊联合肠内营养可以改善脓毒症机械通气患者营养状态,增强机体免疫功能,降低VAP的发病率,缩短ICU住院时间。 Objective To observe the effect of bifidobacterium triple viable capsule combined with enteral nutrition via nasogastric tube in the prevention of ventilator-associated pneumonia(VAP)in patients with sepsis and mechanical ventilation,and its impact on nutritional status and immune function of patients.Method A total of 102 patients with septic mechanical ventilation admitted to the intensive care unit(ICU)of our hospital from September 2019 to January 2021 were randomly divided into C group(n=50)and L group(n=52).The patients in both groups were treated with enteral nutrition with nasogastric tube within 24-72h after admission.The L group was treated with lactobacillus and enterococcus powder besides on the basis of the C group,The nutritional indexes[serum total protein(TP),albumin(ALB),prealbumin(PA),hemoglobin(HB)]and immune indexes[CD3^(+),CD4^(+),CD4^(+)/CD8^(+),secretory immunoglobulin A(SIgA)]of the two groups before and 14 days after treatment were statistically compared with VAP,bacteremia,disease death rate,mechanical ventilation time and ICU hospitalization time 28 days after treatment.Result 14 days after treatment,the levels of serum TP,ALB,PA and Hb in the L group were higher than those in the C group(P<0.01).On the 14th day after treatment,the levels of serum CD3^(+),CD4^(+),CD4^(+)/CD8^(+)and SIgA in the L group were higher than those in the C group(P<0.05).The incidence rate of VAP in the L group was lower than that in the C group(χ^(2)=3.922,P=0.048).The ventilation time and ICU stay in the L group were shorter than those in the C group(t=2.264,2.054,P=0.013,0.021).The incidence rate and mortality rate of the L group were lower than those of the C group,but the difference was not statistically significant(χ^(2)=1.230,0.631,P=0.267,0.427).The incidence of gastric retention,abdominal distension,diarrhea and constipation in group L was lower than that in group C(χ^(2)=5.480,15.291,15.653,7.233,P=0.019,<0.001,<0.001,0.007).Conclusion lactobacillus and enterococcus powder besides combined with ent

关 键 词： 双歧杆菌三联活菌胶囊 肠内营养 脓毒症 机械通气 呼吸机相关性肺炎

领　　域： [医药卫生—呼吸系统] [医药卫生—内科学] [医药卫生—临床医学]