益生菌联合早期肠内营养对ICU机械通气患者感染及胃肠功能障碍的影响

目的 分析在重症监护病房（ICU）机械通气患者中应用益生菌联合早期肠内营养治疗对感染、胃肠功能障碍的影响。方法 采用前瞻性队列研究方法，选取2016年2月—2017年10月入住某院ICU行机械通气的患者，采用随机数字法分为A、B、C三组。A组行早期肠内营养联合益生菌治疗，B组行早期肠内营养治疗，C组行早期肠外营养治疗。比较三组患者感染情况、感染指标水平（治疗后第3天、第7天、第14天）、胃肠功能障碍发生情况、治疗后第14天急性生理功能和慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分值。结果 A组患者感染发生率为6.00%，B组为20.00%，C组为22.00%，三组患者感染发生率比较，差异有统计学意义（χ²=8.57，P=0.01）。第7天、第14天A组患者的C反应蛋白（CRP）、白细胞计数（WBC）均低于B、C组；第3天A、B组患者的降钙素原（PCT）均较C组低；第7天、第14天A组患者的PCT较B、C组低；差异均有统计学意义（均P<0.05）。A组患者腹胀（8.00%）、腹泻（4.00%）、胃潴留（4.00%）的发生率均为三组最低。治疗后第14天A组患者的APACHE Ⅱ评分最低。结论 早期肠内营养联合益生菌治疗ICU机械通气患者能有效降低感染及胃肠功能障碍发生率，促进康复，值得推广、应用。

Effect of probiotics combined with early enteral nutrition on infection and gastrointestinal dysfunction in patients undergoing mechanical ventilation in intensive care unit

Objective To analyze the effect of probiotics combined with early enteral nutrition on infection and gastrointestinal dysfunction in patients undergoing mechanical ventilation in intensive care unit (ICU). Methods Prospective cohort study was adopted to select patients who admitted to ICU in a hospital from February 2016 to October 2017, they were randomly divided into three groups:A, B, and C. Group A received early enteral nutrition combined with probiotics, group B received early enteral nutrition, and group C received early parenteral nutrition. Infection condition, level of infection indicators (on the 3rd, 7th and 14th day after treatment), occurrence of gastrointestinal dysfunction, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) on the 14th day after treatment were compared among three groups. Results Incidences of infection in group A, B, and C were 6.00%, 20.00%, and 22.00% respectively, difference among three groups was significant (χ²=8.57, P=0.01). C-reactive protein (CRP) and white blood cell count (WBC) in group A on the 7th and 14th day were both lower than those in group B and C; procalcitonin (PCT) in group A and B on the 3rd day were both lower than that in group C; PCT in group A on the 7th and 14th day were both lower than those in group B and C; difference were all statistically significant (all P< 0.05). Incidence of abdominal distension (8.00%), diarrhea (4.00%) and gastric retention (4.00%) in group A were the lowest among three groups. APACHE Ⅱ score in group A on the 14th day after treatment was lowest. Conclusion Early enteral nutrition combined with probiotics for treatment of ICU patients with mechanical ventilation can effectively reduce the incidence of infection and gastrointestinal dysfunction, promote rehabilitation, which is worth promoting the application.