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

doi:10.19871/j.cnki.xfcrbzz.2023.03.006

Abstract

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

CLC Number:

R563.1

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.

References

[1] 张静雯, 庞燕, 耿男, 等. 病毒性脓毒症的研究进展与启发[J]. 中国急救医学, 2021, 41(3):270-274.
[2] RUDD KE, JOHNSON SC, AGESA KM, et al.Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study[J]. Lancet, 2020, 395(10219):200-211.
[3] 吴森泉, 方年新, 莫伟良, 等. 山柰酚抑制NLRP3炎症小体活化和细胞焦亡提高脓毒症小鼠生存率[J/CD]. 新发传染病电子杂志,2022, 7(1):12-16.
[4] KAWAZOE Y, MIYAMOTO K, MORIMOTO T, et al.Dexmedetomidine for Sepsis in Intensive Care Unit Randomized Evaluation (DESIRE) Trial Investigators. Effect of Dexmedetomidine on Mortality and Ventilator-Free Days in Patients Requiring Mechanical Ventilation With Sepsis: A Randomized Clinical Trial[J]. JAMA, 2017, 317(13):1321-1328.
[5] ZAMPIERI FG, MAZZA B.Mechanical Ventilation in Sepsis: A Reappraisal[J]. Shock, 2017, 47(1S Suppl 1):41-46.
[6] SHIMIZU K, YAMADA T, OGURA H, et al.Synbiotics modulate gut microbiota and reduce enteritis and ventilator-associated pneumonia in patients with sepsis: a randomized controlled trial[J]. Crit Care, 2018, 22(1):1-9.
[7] 颜骏, 蔡燕, 张清艳, 等. 脓毒症早期肠道菌群失调相关危险因素及其对预后的影响[J/CD]. 中华危重症医学杂志(电子版), 2020, 13(5):328-333.
[8] 郭青春, 张杰根, 张硕, 等. 微生态制剂双歧杆菌三联活菌胶囊辅助治疗老年性肺炎的临床效果[J]. 中国医药导报, 2019, 16(6):126-129.
[9] SINGER M, DEUTSCHMAN CS, SEYMOUR CW, et al.The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)[J]. JAMA, 2016, 315(8):801-810.
[10] 中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版)[J]. 中华结核和呼吸杂志, 2018, 41(4):255-280.
[11] 沈丽娟, 周永华, 关云艳, 等. 脓毒症肠道微环境变化的研究进展[J]. 中国病原生物学杂志, 2018, 13(10):1166-1174.
[12] 谢吐秀, 吕菁君, 魏捷, 等. 脓毒症致肠道菌群失调机制与治疗的研究[J]. 医学研究杂志, 2018, 47(8):184-187.
[13] 马磊, 王高飞, 吴嘉荔, 等. 益生菌和丙氨酰谷氨酰胺联合应用对脓毒症患者肠道黏膜屏障的保护作用[J]. 宁夏医科大学学报, 2018, 40(9):1035-1038.
[14] 杨洋, 赵勇. 丙氨酰谷氨酰胺及双歧杆菌三联活菌胶囊在结直肠癌术后辅助化疗中对肠道屏障功能的影响[J]. 中国现代医学杂志, 2020, 30(15):79-84.
[15] SHI J, GAO F, ZHANG J.Effect of Combined Live Probiotics Alleviating the Gastrointestinal Symptoms of Functional Bowel Disorders[J]. Gastroenterol Res Pract, 2020, 17(1):1-11.
[16] REN C, YAO RQ, ZHANG H, et al.Sepsis-associated encephalopathy: a vicious cycle of immunosuppression[J]. J Neuroinflammation, 2020, 17(1):14.
[17] 杨蓉, 王鹏, 屈文静. 脓毒症患者继发持续性炎症-免疫抑制-分解代谢综合征的影响因素及预测模型构建[J]. 海南医学, 2021, 32(17):2182-2185.
[18] 李媛媛, 颜睿瑛, 李冬纯, 等. 含益生菌肠内营养干预对危重脑出血术后患者肠道菌群和炎症状态的影响[J]. 河北医学, 2019, 25(3):572-577.
[19] 刘福生, 刘锦, 孙琛琛, 等. 温下健脾法联合抗菌药物治疗脓毒症的实验研究[J]. 中国中西医结合急救杂志, 2019, 26(5):533-538.
[20] 王丽辉, 孙治霞, 索红亮, 等. 基于HMGB1/TLR4/NF-κB通路探讨桃仁承气汤调节肠源性脓毒症大鼠肠道肌电活动及微环境稳态的作用机制[J]. 中国实验方剂学杂志, 2020, 26(12):78-84.
[21] 杜军武, 赵铁军. 双歧杆菌三联活菌胶囊联合奥曲肽治疗急性重症胰腺炎疗效研究[J]. 创伤与急危重病医学, 2019, 7(5):301-304.
[22] 赵辉, 李荣发, 王凯, 等. 益生菌联合早期肠内营养对老年脓毒症患者炎症反应及免疫功能的影响[J]. 中国老年学杂志, 2018, 38(10):2425-2427.