目的 探討雙歧桿菌乳桿菌三聯(lián)活菌片聯(lián)合腸內(nèi)營(yíng)養(yǎng)混懸液改善膿毒癥的臨床意義。方法 選擇2012年5月-2014年4月沈陽(yáng)市第四人民醫(yī)院收治的膿毒癥患者100例,隨機(jī)分為對(duì)照組和治療組,每組50例。對(duì)照組在對(duì)癥治療基礎(chǔ)上給予腸內(nèi)營(yíng)養(yǎng)混懸液,從30 mL/h開(kāi)始,每4小時(shí)監(jiān)測(cè)患者胃潴留量1次,依患者耐受情況酌情增加鼻飼量,維持量一般60～100 mL/h。治療組在對(duì)照組基礎(chǔ)上應(yīng)用雙歧桿菌乳桿菌三聯(lián)活菌片4 片/次,碾碎后溫開(kāi)水溶解鼻飼,3次/d。兩組均連續(xù)治療8 d。比較兩組治療前及治療2、4、8 d時(shí)營(yíng)養(yǎng)指標(biāo)血漿白蛋白(ALB)、前白蛋白(PA)、轉(zhuǎn)鐵蛋白(TRF),血糖,感染性指標(biāo)降鈣素原(PCT)、C反應(yīng)蛋白(CRP)的變化,同時(shí)比較兩組不良反應(yīng)發(fā)生情況。結(jié)果 對(duì)照組在治療第8天,ALB、PA、TRF均較治療前顯著升高;治療組在第4、8天這些營(yíng)養(yǎng)指標(biāo)較治療前顯著升高,同組差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療組在治療第4、8天,ALB、PA、TRF高于對(duì)照組,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療組在治療第4、8天時(shí),血糖水平較治療前明顯下降,差異具有統(tǒng)計(jì)學(xué)意義(P<0.05);治療第4、8天時(shí),治療組血糖水平明顯低于對(duì)照組,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療第2、4、8天兩組患者的CRP、PCT均較治療前顯著降低,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);且治療組這些指標(biāo)的降低程度優(yōu)于對(duì)照組,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論 雙歧桿菌乳桿菌三聯(lián)活菌片聯(lián)合腸內(nèi)營(yíng)養(yǎng)混懸液對(duì)膿毒癥患者具有較好的營(yíng)養(yǎng)支持效果,可以改善膿毒癥患者應(yīng)激性高血糖,抑制炎癥反應(yīng),減少胃腸道不良反應(yīng)發(fā)生率,值得臨床推廣應(yīng)用。

Objective To explore the clinical effect of Live Combined Bifidobacterium and Lactobacillus Tablets combined with Enteral Nutritional Suspension in the improvement of sepsis. Methods The patients with sepsis (100 cases) of Shenyang the Fourth Hospital of People from May 2012 to April 2014 were randomly divided into control and treatment groups, and each group had 50 cases. The patients in the control group were given enteral nutritional suspension on the basis of symptomatic treatment, beginning from 30 mL/h, and gastric retention amount were monitored every 4 h. Nasal feeding amounts were increased according to the situation of patients, and the amounts of maintaining were general 60-100 mL/h. The patients in the treatment group were given Live Combined Bifidobacterium and Lactobacillus Tablets on the basis of control group, 4 tablets/time, dissolved with warm boiling water after crushed, three times daily. The patients in two groups were treated for 8 d. The changes of nutrient indexes including ALB, PA, TRF, blood glucose, infectious indexes including CRP, PCT before treatment and 2, 4, 8 d after the treatment in two groups were compared. At the same time, incidence of adverse reactions in two groups were compared. Results ALB, PA, and TRF in the control group was significant improved on the eighth day of treatment, while these nutrition indexes in the treatment group were significantly increased on the fourth and eighth day of treatment, and the difference was statistically significant in the same group (P< 0.05). ALB, PA, and TRF in the treatment group were higher than those in the control group on the fourth and eighth day of treatment, and there were differences between two groups (P< 0.05). Blood glucose in the treatment group was significantly decreased on the fourth and eighth day of treatment, and the difference was statistically significant in the same group (P< 0.05). Blood glucose in the treatment group was significantly lower than that in the control group on the fourth and eighth day of treatment, and there were differences between the two groups (P< 0.05). CRP and PCT in the two groups were significantly reduced on the second, fourth and eighth day of treatment, and the difference was statistically significant in the same group (P< 0.05). The extent of these indicators in the treatment group was better than those of control group, and there were differences between the two groups (P< 0.05). Conclusion Live Combined Bifidobacterium and Lactobacillus Tablets combined with Enteral Nutritional Suspension has good nutrition support in patients with sepsis, and can improve stress hyperglycemia, while can inhibit inflammatory reaction and reduce the incidence of gastrointestinal adverse reactions, which is worth clinical promotion.