Effects of Probiotics Enteral Nutrition on Ventilator Associated Pneumonia in Patients with Severe Brain Injury
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摘要:
目的 探讨益生菌联合早期肠内营养在重型颅脑损伤患者呼吸机相关性肺炎（ventilator associated pneumonia，VAP）治疗中的作用，以及对肠粘膜屏障功能的影响。 方法 选取2016年9月至2020年11月收住南京医科大学附属苏州医院神经外科的重型颅脑损伤患者84例，随机分为观察组和对照组。2组患者均采用鼻饲早期肠内营养，观察组在此基础上增加益生菌治疗。对比2组患者治疗前后的呼吸机相关性肺炎发生率、肠粘膜屏障功能及胃肠道并发症情况。 结果 与对照组相比，观察组VAP发生率低于对照组，在肠内营养开始后第7、21天超敏C反应蛋白、降钙素原水平显著低于对照组，第7天血浆D-乳酸和二胺氧化酶浓度显著低于对照组，治疗过程中胃肠道并发症显著低于对照组，差异均有统计学意义（P < 0.05）。 结论 益生菌联合早期肠内营养治疗，有助于降低VAP发生率，减少炎症因子释放，保护肠粘膜屏障功能，减少胃肠道并发症。 Abstract:Objective To investigate the effect of probiotics combined with early enteral nutrition in the treatment of severe brain injury patients with VAP and the effect of intestinal mucosal barrier function. Methods A total of 84 patients with severe brain injury admitted to the Neurosurgery Department of Suzhou Hospital affiliated to Nanjing Medical University from September 2016 to November 2020 were randomly divided into observation group and control group. Both groups received early enteral nutrition with nasal feeding, and the observation group received additional probiotics on this basis. The incidence of ventilator-associated pneumonia, intestinal mucosal barrier function and gastrointestinal complications were compared between the two groups before and after treatment. Results Compared with the control group, the incidence of VAP in the observation group is lower, the levels of hypersensitive C-reactive protein and procalcitonin were significantly lower at 7th and 21st days after enteral nutrition, plasma D-lactic acid and diamine oxidase concentrations were significantly lower at 7th day after enteral nutrition. Gastrointestinal complications during treatment were significantly lower than those in the control group. And the differences were statistically significant （P < 0.05）. Conclusion Probiotics combined with early enteral nutrition can reduce the incidence of VAP, reduce the release of inflammatory factors, protect the intestinal mucosal barrier function, and reduce gastrointestinal complications. -
表 1 2组患者一般情况比较[（
$\bar x \pm s $ ）分]Table 1. Comparison of general conditions between thetwo groups [（
$\bar x \pm s $ ）scores]组别 n 年龄（岁） GCS评分 APACHE II评分 观察组 43 50.2 ± 8.7 5.2 ± 1.3 22.7 ± 3.9 对照组 41 49.3 ± 7.4 5.3 ± 1.1 23.4 ± 3.5 t 0.509 0.379 0.864 P 0.611 0.705 0.389 
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表 2 2组患者VAP发生率和超敏CRP比较[
$ \bar x \pm s $ ，n（%）]Table 2. Comparisons of the incidence of VAP and hypersensitive CRP between the two groups[
$ \bar x \pm s $ ，n（%）]组别 VAP 超敏CRP（mg/L） 治疗前 1 d 7 d 21 d 观察组（n = 43） 11（25.58）* 195.1 ± 64.3 196.7 ± 63.9 84.3 ± 42.5* 17.3 ± 11.4* 对照组（n = 41） 23（56.10） 197.8 ± 63.1 193.1 ± 67.4 118.3 ± 58.9 41.2 ± 38.7 t/χ2 8.112 0.194 0.251 3.045 3.878 P 0.004 0.846 0.802 0.003 < 0.001 与对照组比较，*P < 0.05。
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表 3 2组患者PCT比较（
$ \bar x \pm s $ ）Table 3. Comparisons of PCT between the two groups（
$ \bar x \pm s $ ）组别 PCT（μg/L） 治疗前 1 d 7 d 21 d 观察组（n = 43） 3.23 ± 1.38 3.17 ± 1.44 0.97 ± 0.38* 0.13 ± 0.02* 对照组（n = 41） 3.31 ± 1.36 3.38 ± 1.25 1.52 ± 0.61 0.57 ± 0.09 t 0.267 0.665 4.985 31.27 P 0.789 0.507 < 0.001 < 0.001 与对照组比较，*P < 0.05。
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表 4 2组患者血浆D-乳酸和DAO浓度比较（
$ \bar x \pm s $ ）Table 4. Comparisons of Plasma D-lactic acid and DAO concentrations between the two groups（
$ \bar x \pm s $ ）组别 D-乳酸（μg/mL） DAO（U/mL） 1 d 7 d 1 d 7 d 观察组（n = 43） 7.43 ± 1.38 0.96 ± 0.29* 4.17 ± 0.25 1.68 ± 0.11* 对照组（n = 41） 7.62 ± 1.53 1.77 ± 0.64 4.07 ± 0.28 2.97 ± 0.22 t 0.598 7.53 1.728 34.23 P 0.551 < 0.001 0.087 < 0.001 与对照组比较，*P < 0.05。
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表 5 2组患者胃肠道并发症发生率比较[n（%）]
Table 5. Comparison of incidence of gastrointestinal complications between the two groups[n（%）]
组别 腹胀 腹泻 便秘 呕吐 胃肠道
出血观察组
（n = 43）4（9.3）* 2（4.7）* 3（6.9）* 3（6.9）* 1（2.3）* 对照组
（n = 41）11（26.8） 13（31.7） 12（29.2） 10（24.4） 6（14.6） χ2 4.395 10.47 7.11 4.865 4.163 P 0.036 0.001 0.008 0.027 0.041 与对照组比较，*P < 0.05。
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