益生菌联合整蛋白型肠内营养辅助治疗脓毒血症的疗效及对肠道和免疫功能的影响*

Effect of probiotics combined with enteral nutrition with a nonelemental diet on sepsis and intestinal and immune function*

摘要:

目的?探讨益生菌联合整蛋白型肠内营养辅助治疗脓毒血症的疗效及对肠道功能、炎症因子和免疫功能的影响。方法?选取2015年6月—2018年6月保定市第一中心医院西院收治的脓毒血症患者134例。随机分为观察组和对照组。对照组根据患者病情予以抗感染、液体复苏、清创引流、机械通气等治疗。在此基础上，观察组另加用双歧杆菌四联活菌片联合整蛋白型肠道营养进行支持治疗。分别观察两组治疗前和治疗3?d、10?d后APACHE-Ⅱ评分、SOFA评分、肠道功能、炎症因子水平和外周血T淋巴细胞亚群水平。结果?观察组治愈率较对照组高（P?<0.05），病死率较对照组低（P?<0.05）。两组APACHE-Ⅱ评分、SOFA评分在不同时间、不同组间不变化趋势上有差异（P?<0.05）。观察组治疗后肠道功能评分较对照组低（P?<0.05）。两组PCT、IL-6、CRP及SAA水平在不同时间、不同组间不变化趋势上有差异（P?<0.05）。两组CD3+、CD4+和CD4+/CD8+水平在不同时间、不同组间不变化趋势上有差异（P?<0.05）。结论?益生菌联合整蛋白型肠内营养支持治疗脓毒血症，能提高疗效，改善肠道功能，并对炎症因子水平、免疫力的改善有积极作用，有效降低病死率。

Abstract:

Objective To study the efficacy of probiotics combined with enteral nutrition with a nonelemental diet in the treatment of sepsis and its effects on intestinal function, inflammatory factors and immune function. ?Methods?A total of 134 patients with sepsis admitted to our hospital from June 2015 to June 2018 were divided into the observation group (n = 67) and the control group (n = 67) randomly. Both groups were given basic treatment including anti-infection, fluid resuscitation, debridement and drainage, and mechanical ventilation, based on which the observation group was additionally treated with Bifidobacterium quadruple viable tablets combined with enteral nutrition with a nonelemental diet. APACHE-II and SOFA scores, intestinal function, inflammatory factor level and peripheral blood T lymphocyte subsets were observed before treatment, 3 days and 10 days after treatment. The conditions of cure, death or survival outcome in the two groups were followed up for 3 months after discharge.?Results?The cure rate of the observation group [89.55% (60/67)] was higher than that of the control group [79.10% (53/67)], and the mortality rate of the observation group [5.97% (4/67)] was lower than that of the control group [11.94% (8/67)] (P < 0.05). The APACHE-II and SOFA scores of the both group were different at distinct time points (P < 0.05), and were significantly different between the observation group and the control group (P < 0.05). There was a difference in the change trend of APACHE-II and SOFA scores between the observation group and the control group (P < 0.05). There was no statistically significant difference in the intestinal function score before treatment between the observation group and the control group (P > 0.05), while the intestinal function score after treatment of the observation group was higher than that of the control group (P < 0.05). The levels of PCT, IL-6, CRP, and SAA were different at different time points (P < 0.05), and were different between the observation group and control group (P < 0.05). There were differences in the change trends of PCT, IL-6, CRP and SAA levels between the observation group and the control group (P < 0.05). Besides, the levels of CD3+, CD4+ and CD4+ / CD8+ were different at different time points (P < 0.05) and were different between the two groups (P < 0.05). There was a difference in the change trend of CD3+, CD4+ and CD4+ / CD8+ levels between the observation group and the control group (P < 0.05).?Conclusions?Probiotics combined with enteral nutrition with a nonelemental diet can improve the curative effect for sepsis, enhance the intestinal function, positively regulate the inflammatory factors and immunity, and reduce mortality effectively.