双歧杆菌三联活菌胶囊联合肠内营养在脓毒症机械通气 患者呼吸机相关性肺炎预防中的效果研究

doi:10.19871/j.cnki.xfcrbzz.2023.03.006

新发传染病电子杂志 ›› 2023, Vol. 8 ›› Issue (3): 29-33.doi: 10.19871/j.cnki.xfcrbzz.2023.03.006

双歧杆菌三联活菌胶囊联合肠内营养在脓毒症机械通气患者呼吸机相关性肺炎预防中的效果研究

张爱华¹, 赖伟华², 王敏³, 覃明⁴

1.暨南大学附属广州红十字会医院手术室,广东广州 510220;
2.暨南大学附属广州红十字会医院急诊科,广东广州 510220;
3.暨南大学附属广州红十字会医院骨科,广东广州 510220;
4.暨南大学附属广州红十字会医院重症医学科,广东广州 510220

收稿日期:2022-04-28 出版日期:2023-06-30 发布日期:2023-07-20
通讯作者: 王敏,Email：zhenghm66@163.com
基金资助:
1.广州市中医药和中西医结合项目（20202A011011）; 2.广州市卫生健康委科技项目（20211A011021）

Effect of lactobacillus and enterococcus powder besides combined with enteral nutrition in the prevention of VAP in patients with sepsis and mechanical ventilation

Zhang Aihua¹, Lai Weihua², Wang Min³, Qing Ming⁴

1. Operating Room of Guangzhou Red Cross Hospital Affiliated to Jinan University, Guangdong Guangzhou 510220, China;
2. Emergency Department of Guangzhou Red Cross Hospital Affiliated to Jinan University, Guangdong Guangzhou 510220, China;
3. Department of Orthopedics, Guangzhou Red Cross Hospital Affiliated to Jinan University, Guangdong Guangzhou 510220, China;
4. Department of Critical Medicine, Guangzhou Red Cross Hospital to Jinan University, Guangdong Guangzhou 510220, China

Received:2022-04-28 Online:2023-06-30 Published:2023-07-20

摘要/Abstract

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28d VAP、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（χ²=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（χ²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（χ²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。

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

Abstract: 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 (χ²=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 (χ²=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 (χ²=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 enteral nutrition can improve the status of septic patients with mechanical ventilation, enhance immune function, reduce the incidence rate of VAP and shorten the length of stay in ICU patients with sepsis.

Key words: Lactobacillus and enterococcus powder besides, Enteral nutrition, Sepsis, Mechanical ventilation, Ventilator associated pneumonia

中图分类号:

R563.1

张爱华, 赖伟华, 王敏, 覃明. 双歧杆菌三联活菌胶囊联合肠内营养在脓毒症机械通气患者呼吸机相关性肺炎预防中的效果研究[J]. 新发传染病电子杂志, 2023, 8(3): 29-33.

Zhang Aihua, Lai Weihua, Wang Min, Qing Ming. Effect of lactobacillus and enterococcus powder besides combined with enteral nutrition in the prevention of VAP in patients with sepsis and mechanical ventilation[J]. Electronic Journal of Emerging Infectious Diseases, 2023, 8(3): 29-33.

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双歧杆菌三联活菌胶囊联合肠内营养在脓毒症机械通气患者呼吸机相关性肺炎预防中的效果研究

Effect of lactobacillus and enterococcus powder besides combined with enteral nutrition in the prevention of VAP in patients with sepsis and mechanical ventilation

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Effect of lactobacillus and enterococcus powder besides combined with enteral nutrition in the prevention of VAP in patients with sepsis and mechanical ventilation

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