摘要
目的探讨益生菌治疗在降低脓毒症机械通气患者呼吸机相关性肺炎(ventilatorassociated pneumonia,VAP)中的应用效果。方法选取入住本院ICU的脓毒症机械通气的患者共94例,随机(随机数字法)分为益生菌组(n=46)和对照组(n=48),两组患者均于入院后24~72 h内留置鼻胃管行肠内营养治疗,益生菌组在对照组基础上予以益生菌双歧杆菌三联活菌胶囊,统计比较两组患者VAP、菌血症、病死率,机械通气时间、ICU住院时间情况。结果与对照组比较,益生菌组患者的VAP发病率、菌血症的发病率明显低于对照组(χ^(2)=4.763,P=0.029;χ^(2)=4.438,P=0.035);两组患者28 d病死率、住院天数比较差异无统计学意义(χ^(2)=2.02,P=0.167,t=1.29,P=0.208)。益生菌组的机械通气时间短于对照组(t=2.16,P=0.038)。通过log-rank test分析显示益生菌组的无VAP时间明显长于对照组(P<0.05);通过校正APACHEII评分、年龄后,COX比例风险模型分析示对于28 d VAP发病益生菌干预组与对照组的RR值分别为0.18(95%CI:0.12~0.74,P=0.025)和0.21(95%CI:0.19~0.95,P=0.042)。结论益生菌强化治疗能够降低脓毒症患者VAP的发病率,缩短ICU住院时间。
Objective To explore the effect of probiotics on reducing ventilator-associated pneumonia(VAP)in sepsis patients.Methods A total of 94 cases were randomly(random number)divided into the probiotic group(n=46)and the control group(n=48).All of the patients were given enteral nutrition therapy by nasogastric tube within 24-72 h after admission.and patients in the probiotic group were given live combined bifidobacterium,lactobacillus and enterococcus powder besides the regular therapy.The incidence of VAP,bacteremia,mortality,mechanical ventilation time and length of ICU stay were compared between the two groups.Results Compared with the control group,the incidences of VAP and bacteremia in the probiotics group were signifi cantly lower(χ^(2)=4.763,P=0.029;χ^(2)=4.438,P=0.035).There were no signifi cant differences in 28-day mortality and the length of hospital stay between the two groups(χ^(2)=2.02,P=0.167;t=1.29,P=0.208).Mechanical ventilation time in the probiotics group was signifi cantly shorter than that in the control group(t=2.16,P=0.038).The log-rank test showed that the time of VAP-free in the probiotics group was significantly longer than that in the control group(P<0.05).After adjusting for APACHEⅡscore and age,COX proportional risk model analysis showed that the RR values of the probiotics group and the control group for 28-day VAP were 0.18(95%CI:0.12-0.74,P=0.025)and 0.21(95%CI:0.19-0.95,P=0.042),respectively.Conclusions Probiotics treatment can reduce the incidence of VAP in sepsis patients.
作者
陈娇
贾凌
杨敬辉
薛翔
蔡建芹
徐微笑
赵炜
Chen Jiao;Jia Ling;Yang Jinghui;Xue Xiang;Cai Jianqin;Xu Weixiao;Zhao Wei(Department of Critical Care Medicine,Sir Run Run Hospital,Nanjing Medical University,Nanjing 211100,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2021年第2期179-182,共4页
Chinese Journal of Emergency Medicine
基金
国家自然科学基金项目(81701884)。
关键词
益生菌
脓毒症
机械通气
呼吸机相关性肺炎
Probiotics
Sepsis
Mechanical ventilation
Ventilator-associated pneumonia
