双歧杆菌乳杆菌三联活菌片联合肠内营养混悬液改善脓毒症的临床观察

目的探讨双歧杆菌乳杆菌三联活菌片联合肠内营养混悬液改善脓毒症的临床意义。方法选择2012年5月—2014年4月沈阳市第四人民医院收治的脓毒症患者100例,随机分为对照组和治疗组,每组50例。对照组在对症治疗基础上给予肠内营养混悬液,从30 m L/h开始,每4小时监测患者胃潴留量1次,依患者耐受情况酌情增加鼻饲量,维持量一般60~100 m L/h。治疗组在对照组基础上应用双歧杆菌乳杆菌三联活菌片4片/次,碾碎后温开水溶解鼻饲,3次/d。两组均连续治疗8 d。比较两组治疗前及治疗2、4、8 d时营养指标血浆白蛋白(ALB)、前白蛋白(PA)、转铁蛋白(TRF),血糖,感染性指标降钙素原(PCT)、C反应蛋白(CRP)的变化,同时比较两组不良反应发生情况。结果对照组在治疗第8天,ALB、PA、TRF均较治疗前显著升高;治疗组在第4、8天这些营养指标较治疗前显著升高,同组差异有统计学意义(P0.05)。治疗组在治疗第4、8天,ALB、PA、TRF高于对照组,两组比较差异有统计学意义(P0.05)。治疗组在治疗第4、8天时,血糖水平较治疗前明显下降,差异具有统计学意义(P0.05);治疗第4、8天时,治疗组血糖水平明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗第2、4、8天两组患者的CRP、PCT均较治疗前显著降低,差异有统计学意义(P0.05);且治疗组这些指标的降低程度优于对照组,两组比较差异具有统计学意义(P0.05)。结论双歧杆菌乳杆菌三联活菌片联合肠内营养混悬液对脓毒症患者具有较好的营养支持效果,可以改善脓毒症患者应激性高血糖,抑制炎症反应,减少胃肠道不良反应发生率,值得临床推广应用。

Clinical observation of Live Combined Bifidobacterium and Lactobacillus Tablets combined with Enteral Nutritional Suspension in improvement of sepsis

Objective To explore the clinical effect of Live Combined Bifidobacterium and Lactobacillus Tablets combined with Enteral Nutritional Suspension in the improvement of sepsis. Methods The patients with sepsis (100 cases) of Shenyang the Fourth Hospital of People from May 2012 to April 2014 were randomly divided into control and treatment groups, and each group had 50 cases. The patients in the control group were given enteral nutritional suspension on the basis of symptomatic treatment, beginning from 30 mL/h, and gastric retention amount were monitored every 4 h. Nasal feeding amounts were increased according to the situation of patients, and the amounts of maintaining were general 60-100 mL/h. The patients in the treatment group were given Live Combined Bifidobacterium and Lactobacillus Tablets on the basis of control group, 4 tablets/time, dissolved with warm boiling water after crushed, three times daily. The patients in two groups were treated for 8 d. The changes of nutrient indexes including ALB, PA, TRF, blood glucose, infectious indexes including CRP, PCT before treatment and 2, 4, 8 d after the treatment in two groups were compared. At the same time, incidence of adverse reactions in two groups were compared. Results ALB, PA, and TRF in the control group was significant improved on the eighth day of treatment, while these nutrition indexes in the treatment group were significantly increased on the fourth and eighth day of treatment, and the difference was statistically significant in the same group (P< 0.05). ALB, PA, and TRF in the treatment group were higher than those in the control group on the fourth and eighth day of treatment, and there were differences between two groups (P< 0.05). Blood glucose in the treatment group was significantly decreased on the fourth and eighth day of treatment, and the difference was statistically significant in the same group (P< 0.05). Blood glucose in the treatment group was significantly lower than that in the control group on the fourth and eighth day of treatment, and there were differences between the two groups (P< 0.05). CRP and PCT in the two groups were significantly reduced on the second, fourth and eighth day of treatment, and the difference was statistically significant in the same group (P< 0.05). The extent of these indicators in the treatment group was better than those of control group, and there were differences between the two groups (P< 0.05). Conclusion Live Combined Bifidobacterium and Lactobacillus Tablets combined with Enteral Nutritional Suspension has good nutrition support in patients with sepsis, and can improve stress hyperglycemia, while can inhibit inflammatory reaction and reduce the incidence of gastrointestinal adverse reactions, which is worth clinical promotion.