益生菌联合早期肠内营养干预对 重症脑卒中患者营养状态及肠道菌群的影响

目的探讨益生菌联合早期肠内营养干预对重症脑卒中患者营养状态及肠道菌群的影响。方法选取2014年1月至2018年6月于我院住院治疗的重症脑卒中患者70例,随机分为观察组和对照组各35例。两组患者均予控制颅内压、营养神经细胞、抗生素预防感染、保护胃黏膜和维持水电解质酸碱平衡等基础治疗。对照组患者留置鼻饲管行常规肠内营养治疗,观察组患者在对照组治疗基础上加用双歧杆菌四联活菌片水化后鼻饲管注入,1.5 g/次,3次/d,连用10 d。观察两组患者治疗前和治疗10 d后营养状态指标血清总蛋白(TP)、转铁蛋白(TF)、上臂三头肌肌围(MAMC)]的变化,并比较治疗后肠道菌群(双歧杆菌、乳杆菌、拟杆菌、肠球菌、大肠埃希菌)数量变化。结果治疗10 d后,两组患者血清TP、TF水平和MAMC较治疗前显著下降(P0.05),且治疗后观察组患者TP、TF水平和MAMC高于对照组(P0.05);同时治疗后观察组患者粪便中双歧杆菌、乳杆菌和拟杆菌数量高于对照组,肠球菌和大肠埃希菌数量低于对照组(P0.05)。结论益生菌联合早期肠内营养干预不仅可显著减缓重症脑卒中患者的营养状态恶化;而且能有效地纠正肠道菌群失调,维持肠道微生态的稳定。

Influence of probiotics combined with early enteral nutrition intervention on nutrition condition and intestinal flora of patients with severe stroke

Abstract: Objective To discuss the influence of probiotics combined with early enteral nutrition intervention on nutrition condition and intestinal microecology of patients with severe stroke. Methods 70 patients with severe stroke in our hospital from January 2014 to June 2018 were divided into observation group or control group with 35 cases in either group. Both groups were given basic treatment including intracranial pressure control, brain cell nutrition, infection prevention, gastric mucosa protection and maintenance of water-electrolyte acid-base balance, as well as conventional enteral nutrition treatment through nasogastric gavage, while the patients in observation group were additionally given Bifidobacterium Tetravaccine Tablets via nasogastric gavage, 1.5 g tid, for 10 days. The changes of nutrition condition total protein (TP), transferrin (TF) and MAMC] and quantities of intestinal flora (Bifidobacteria, Lactobacilli, Bacteroides, Enterococci and Escherichia coli) of patients in both groups were observed and compared before and after treatment. Results After treatment, the levels of TP, TF and MAMC of patients in both groups obviously declined (Ps<0.05); the levels of TP, TF and MAMC in observation group were higher than those in control group respectively after treatment (Ps<0.05). The quantities of Bifidobacteria, Lactobacilli and Bacteroides in the feces of patients in observation group were higher, while those of Enterococci and Escherichia coli were lower than in control group respectively after treatment (Ps<0.05). Conclusion Probiotics combined with early enteral nutrition intervention can not only delay the worsening of nutrition condition, but also effectively adjust the disorder of intestinal flora and maintain the stability of intestinal microecology in patients with severe stroke.