| 姚志楠,董桂娟,于 涵,张 清,左冬晶,张艳慧.益生菌早期肠内营养对重型颅脑损伤机械通气患者营养状况和炎症因子的影响及呼吸机相关性肺炎的相关因素分析[J].,2023,(6):1060-1065 |
| 益生菌早期肠内营养对重型颅脑损伤机械通气患者营养状况和炎症因子的影响及呼吸机相关性肺炎的相关因素分析 |
| Effect of Probiotic Early Enteral Nutrition on Nutritional Status and Inflammatory Factors in Patients with Severe Craniocerebral Injury Undergoing Mechanical Ventilation and Analysis of Related Factors of Ventilator-Associated Pneumonia |
| 投稿时间：2022-08-19 修订日期：2022-09-16 |
| DOI：10.13241/j.cnki.pmb.2023.06.012 |
| 中文关键词: 益生菌 早期肠内营养 重型颅脑损伤 机械通气 营养状况 炎症因子 呼吸机相关性肺炎 影响因素 |
| 英文关键词: Probiotic Early enteral nutrition Severe craniocerebral injury Mechanical ventilation Nutritional status Inflammatory factors Ventilator-associated pneumonia Influence factor |
| 基金项目:北京市自然科学基金项目（7162071） |
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| 摘要 目的：探讨益生菌早期肠内营养对重型颅脑损伤（SCCI）机械通气患者营养状况和炎症因子的影响，并分析呼吸机相关性肺炎（VAP）的影响因素。方法：选取我院2021年2月~2022年4月期间收治的SCCI患者102例，根据随机数字表法将患者分为对照组（n=51）和研究组（n=51），在常规治疗的基础上，对照组给予早期肠内营养支持治疗，研究组给予益生菌结合早期肠内营养支持治疗。对比两组机械通气时间和住院时间、营养状况及炎症因子变化情况，记录两组治疗期间VAP的发生情况。根据是否发生VAP将所有患者分为VAP组和无VAP组，应用单因素及多因素Logistic回归分析SCCI机械通气患者VAP发生的影响因素。结果：研究组的机械通气时间和住院时间短于对照组，VAP发生率低于对照组（P<0.05）。两组治疗后白蛋白（ALB）、转铁蛋白（TF）、血红蛋白（Hb）升高，且研究组高于对照组（P<0.05）。两组治疗后白介素-6（IL-6）、 C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、降钙素原（PCT）下降，且研究组低于对照组（P<0.05）。单因素分析结果显示：VAP发生与年龄、建立人工气道方式、日均吸痰次数、口腔护理次数、日均气道湿化次数、手术次数、合并复合伤、误吸、术前GCS评分、机械通气时间有关（P<0.05）。多因素Logistic回归分析结果显示：年龄≥60岁、术前GCS评分偏高、建立人工气道方式为气管切开、手术次数为2次、日均气道湿化次数<3次、误吸、机械通气时间偏长均是SCCI机械通气患者VAP发生的危险因素（P<0.05）。结论：益生菌早期肠内营养可缩短SCCI患者机械通气时间和住院时间，促进营养状况改善，降低炎症因子水平。同时，SCCI患者术后VAP的发生率较高，年龄、术前GCS评分、建立人工气道方式、手术次数、日均气道湿化次数、误吸、机械通气时间均是SCCI机械通气患者VAP发生的影响因素。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effects of probiotic early enteral nutrition on nutritional status and inflammatory factors in patients with severe craniocerebral injury (SCCI) undergoing mechanical ventilation, and to analyze the influencing factors of ventilator-associated pneumonia (VAP). Methods: 102 patients with SCCI who were admitted to our hospital from February 2021 to April 2022 were selected, and they were divided into control group (n=51) and study group (n=51) according to the random number table method. On the basis of conventional treatment, the control group was given early enteral nutrition support treatment, while the study group was given probiotic combined with early enteral nutrition support treatment. The duration of mechanical ventilation, hospital stay, nutritional status and inflammatory factors changes were compared in the two groups, and the occurrence of VAP in the two groups during treatment was recorded. All patients were divided into VAP group and non-VAP group according to the occurrence of VAP. Univariate and multivariate Logistic regression analysis was used to analyze the influencing factors of the occurrence of VAP in mechanical ventilation patients with SCCI. Results: The time of mechanical ventilation and hospital stay in the study group were shorter than those in the control group, and the incidence rate of VAP was lower than that in the control group (P<0.05). After treatment, the albumin (ALB), transferrin (TF) and hemoglobin (Hb) in the two groups were increased, and the study group was higher than the control group (P<0.05). After treatment, interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), procalcitonin (PCT) in the two groups decreased, and the study group was lower than the control group (P<0.05). The results of univariate analysis showed that the incidence of VAP was related to age, the way of establishing artificial airway, the daily number of sputum aspiration, the number of oral care, the daily number of airway humidification, the number of operations, combined with compound injury, aspiration, preoperative GCS score, and the time of mechanical ventilation (P<0.05). The results of multivariate Logistic regression analysis showed that age greater than or equal to 60 years, high preoperative GCS score, tracheotomy as the way of establishing artificial airway, 2 times of number of operations, daily number of airway humidification less than 3 times, aspiration, and longer time of mechanical ventilation were all risk factors for VAP in patients with SCCI mechanical ventilation (P<0.05). Conclusion: Probiotic early enteral nutrition can shorten the time of mechanical ventilation and hospital stay in patients with SCCI, promote the improvement of nutritional status, and reduce the level of inflammatory factors. At the same time, the incidence of postoperative VAP in patients with SCCI is high. Age, preoperative GCS score, the way of establishing artificial airway, the number of operations, the average daily number of airway humidification, aspiration, and the time of mechanical ventilation are the influencing factors of VAP in patients with SCCI undergoing mechanical ventilation. |
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