添加益生菌的肠内营养对老年骨折术后患者肠道菌群变化及预后的影响

目的 探讨添加益生菌的肠内营养与传统肠内营养对老年骨折术后患者肠道菌群变化及预后的影响.方法 选择MNA-SF评分为0~7分的老年骨折手术患者58例,随机分为添加益生菌的肠内营养组(试验组,n=28)和常规肠内营养组(对照组,n=30).2组患者均给予等氮等热卡肠内营养配餐,均按照热量105 kJ·kg-1·d-1、蛋白质1.5 g·kg-1·d-1计算.试验组在此基础上给予益生菌粉剂,对照组未给予,其余治疗相同.分别于术前1次、术后第1次和第10天排粪便时,留取新鲜粪便进行肠道菌群分析,记录患者每日胃肠道不适情况和感染性并发症发生情况.结果 试验组患者肠道菌群在不同观察时间点进行比较,双歧杆菌和乳酸杆菌的菌种数量分别比较,差异均有统计学意义(P<0.05);分别进行两两比较发现,在术前1次和术后第10天的分别比较,差异均有统计学意义(P<0.05);在术后第1次和第10天的分别比较,差异均有统计学意义(P<0.05).对照组患者肠道菌群在不同观察时间进行比较,产气荚膜梭菌的菌种数量比较,差异有统计学意义(P<0.05);分别进行两两比较发现,在术前1次和术后第10天的比较,差异有统计学意义(P<0.05).2组患者肠道菌群进行比较,术后第10天双歧杆菌、乳酸杆菌和产气荚膜梭菌的菌种数量分别比较,差异均有统计学意义(P<0.05).2组患者腹胀和便秘的发生率分别比较,差异均有统计学意义(P<0.05).试验组患者感染性并发症发生率低于对照组,但比较差异无统计学意义(P>0.05).结论 益生菌强化肠内营养有调整老年骨折术后患者肠道菌群功能的作用,并可减少患者胃肠道不适中腹胀和便秘的发生.

The effects of enteral nutrition with probiotics and traditional enteral nutrition on intestinal flora and prognosis in elderly patients with bone fracture after surgery

Objcctive To investigate the effects of enteral nutrition with probiotics and traditional enteral nutrition on intestinal flora and prognosis in elderly patients with bone fracture after surgery.Methods Fifty-eight elderly patients with bone fracture whose MNA-SF scores were 0~7 points were randomly divided into two groups: enteral nutrition with probiotics group (experiment group,n=28) and routine enteral nutrition group (control group,n=30).The patients in both groups were given the same amount of nitrogen and protein (=1.5g·kg-1·d-1) and calories (=105kJ·kg-1·d-1).In addition to that, the patients in experimental group were given probiotics powder.The faeces samples of patients were collected for three time points:the last excretion before surgery,the first excretion after surgery and on 10d after surgery.The changes of intestinal flora,incidence rate of infection and uncomfortable feelings in digestive tract were observed and compared between two groups.Results In experiment group,there was significant difference in the number of bifidobacterium and lactobacillus inside intestinal tract in different time points (P<0.05),moreover, there was significant difference in the number of bifidobacterium and lactobacillus between last excretion before surgery and on 10d after surgery as well as between the first excretion after surgery and on 10d after surgery (P<0.05).In control group, there was significant difference in the number of clostridium perfringens inside intestinal tract in different time points (P<0.05),moreover, there was significant difference in the number of clostridium perfringens between last excretion before surgery and on 10d after surgery (P<0.05).Moreover there was significant difference in the number of bifidobacterium, lactobacillus and clostridium perfringens inside intestinal tract on 10d after surgery between two groups (P<0.05).Besides there were significant differences in the incidence rates of abdominal distension and constipation between two groups (P<0.05).The incidence rate of infection in experiment group was lower than that in control group, but there was no significant difference between two groups (P>0.05).Conclusion The probiotics enrichment enteral nutrition can regulate intestinalflora function of elderly patients with bone fractureand can promote postoperative recovery,moreover,which can decrease the incidence rates of abdominaldistension and constipation ofpatients.