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目的探讨双歧杆菌、嗜热链球菌、保加利亚乳杆菌和嗜酸乳杆菌四联活菌制剂对危重症患者肠道屏障功能的影响及疗效观察。方法选择新疆维吾尔自治区人民医院重症监护室2014年5月至2015年2月收治的危重症患者中64例肠道屏障功能障碍的患者,按照随机数字表法随机分为观察组和对照组。两组患者均给予基础治疗加营养治疗。在营养治疗方面,对照组给予常规营养治疗,观察组在常规营养治疗的基础上加用四联活菌制剂,800mL/d。观察两组患者在治疗前及治疗后7、14d外周血二胺氧化酶(DAO),血浆D-乳酸,血清内毒素的变化;观察两组患者腹泻治疗情况。结果两组患者治疗后7、14d肠黏膜屏障功能3项指标有明显降低,观察组治疗14d后肠黏膜屏障功能3项指标较对照组降低幅度更大,差异有统计学意义(P<0.01)。患者治疗腹泻总有效率观察组为96.7%,对照组为70.0%,两组间比较差异有统计学意义(P<0.05)。结论四联活菌制剂可以明显改善危重症患者肠道通透性,同时改善肠道微生态平衡,修复肠黏膜屏障功能,对危重症患者腹泻有显著的治疗作用,进而改善患者的预后,提高临床疗效,应在临床上推广应用。
Objective To investigate the effects of Bifidobacterium, Streptococcus thermophilus, Lactobacillus bulgaricus and Lactobacillus acidophilus on intestinal barrier function in critically ill patients and to observe its curative effect. Methods Sixty-four patients with intestinal barrier dysfunction who were admitted to intensive care unit of People’s Hospital of Xinjiang Uygur Autonomous Region from May 2014 to February 2015 were randomly divided into observation group and control group according to random number table method. Two groups of patients were given basic treatment plus nutrition treatment. In the aspect of nutrition treatment, the control group was given routine nutrition treatment, and the observation group was given the routine viable treatment with 800ml / d. The change of diamine oxidase (DAO), plasma D-lactate and serum endotoxin in the two groups before and after 7 and 14 days of treatment were observed. Diarrhea treatment was observed in both groups. Results The three indexes of intestinal mucosal barrier function in the two groups were significantly decreased at 7 and 14 days after treatment. The three indicators of intestinal mucosal barrier function in the observation group were significantly lower than those in the control group 14 days after treatment (P <0.01) . The total effective rate of patients treated with diarrhea was 96.7% in the observation group and 70.0% in the control group, with significant difference between the two groups (P <0.05). Conclusion Tetragenic viable preparations can significantly improve the intestinal permeability of critically ill patients, meanwhile, improve intestinal microflora balance, repair intestinal mucosal barrier function, have significant therapeutic effects on diarrhea in critically ill patients, and then improve the prognosis of patients and improve Clinical efficacy, should be clinically applied.