中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2013年
10期
627-630
,共4页
谭敏%卢小岚%段军伟%彭华%朱京慈
譚敏%盧小嵐%段軍偉%彭華%硃京慈
담민%로소람%단군위%팽화%주경자
颅脑损伤%益生菌%高血糖
顱腦損傷%益生菌%高血糖
로뇌손상%익생균%고혈당
Craniocerebral trauma%Probiotics%Hyperglycemia
目的 探讨益生菌对重型颅脑损伤患者血糖水平及预后的影响.方法 采用前瞻性随机对照研究方法,选择住本院神经外科重症监护病房(ICU)52例重型颅脑损伤患者,并按随机数字表法分为试验组及对照组,每组26例.所有患者均按照《颅脑创伤临床救治指南》的要求给予手术、脱水、抗感染、抗癫痫、营养脑细胞、保护胃黏膜等常规治疗,并于入院后24～48 h内开始经鼻胃管行肠内营养;试验组在此基础上给予益生菌制剂3.5 g、每日3次,使每日益生菌总量为1×109个,连续使用21 d.比较两组干预前及干预4、8、15、21 d清晨空腹血糖水平、住院期间胰岛素使用情况、格拉斯哥昏迷评分(GCS)、ICU住院日及28d病死率.结果 两组患者干预前血糖水平无明显差异,而试验组在干预8d、15d时清晨空腹血糖水平显著低于对照组(mmol/L.8d:6.6±1.2比8.0±2.7,t=-2.500,P=0.017;15d:6.1±1.4比7.2±2.2,t=-2.269,P=0.028).试验组胰岛素使用率及使用胰岛素天数(d)均明显少于对照组[19.2％(5/26)比46.2％(12/26),x2=4.282,P=0.039;1.6±0.9比4.3±3.1,t=-2.698,P=0.017];试验组ICU住院日明显短于对照组(d:6.8±3.8比10.7±7.3,t=-2.123,P=0.034).试验组和对照组干预前后GCS分值(分,干预前:6.3±1.0比6.4±1.0,t=-0.408,P=0.685;干预21 d:10.1±4.0比9.6±4.3,t=0.435,P=0.665)及28 d病死率[11.5％(3/26)比19.2％(5/26),x2=0.148,P=0.701]比较差异均无统计学意义.结论 益生菌有利于重型颅脑损伤患者的血糖控制,但其内在机制以及对远期预后的影响还需要进一步的研究探讨.
目的 探討益生菌對重型顱腦損傷患者血糖水平及預後的影響.方法 採用前瞻性隨機對照研究方法,選擇住本院神經外科重癥鑑護病房(ICU)52例重型顱腦損傷患者,併按隨機數字錶法分為試驗組及對照組,每組26例.所有患者均按照《顱腦創傷臨床救治指南》的要求給予手術、脫水、抗感染、抗癲癇、營養腦細胞、保護胃黏膜等常規治療,併于入院後24～48 h內開始經鼻胃管行腸內營養;試驗組在此基礎上給予益生菌製劑3.5 g、每日3次,使每日益生菌總量為1×109箇,連續使用21 d.比較兩組榦預前及榦預4、8、15、21 d清晨空腹血糖水平、住院期間胰島素使用情況、格拉斯哥昏迷評分(GCS)、ICU住院日及28d病死率.結果 兩組患者榦預前血糖水平無明顯差異,而試驗組在榦預8d、15d時清晨空腹血糖水平顯著低于對照組(mmol/L.8d:6.6±1.2比8.0±2.7,t=-2.500,P=0.017;15d:6.1±1.4比7.2±2.2,t=-2.269,P=0.028).試驗組胰島素使用率及使用胰島素天數(d)均明顯少于對照組[19.2％(5/26)比46.2％(12/26),x2=4.282,P=0.039;1.6±0.9比4.3±3.1,t=-2.698,P=0.017];試驗組ICU住院日明顯短于對照組(d:6.8±3.8比10.7±7.3,t=-2.123,P=0.034).試驗組和對照組榦預前後GCS分值(分,榦預前:6.3±1.0比6.4±1.0,t=-0.408,P=0.685;榦預21 d:10.1±4.0比9.6±4.3,t=0.435,P=0.665)及28 d病死率[11.5％(3/26)比19.2％(5/26),x2=0.148,P=0.701]比較差異均無統計學意義.結論 益生菌有利于重型顱腦損傷患者的血糖控製,但其內在機製以及對遠期預後的影響還需要進一步的研究探討.
목적 탐토익생균대중형로뇌손상환자혈당수평급예후적영향.방법 채용전첨성수궤대조연구방법,선택주본원신경외과중증감호병방(ICU)52례중형로뇌손상환자,병안수궤수자표법분위시험조급대조조,매조26례.소유환자균안조《로뇌창상림상구치지남》적요구급여수술、탈수、항감염、항전간、영양뇌세포、보호위점막등상규치료,병우입원후24～48 h내개시경비위관행장내영양;시험조재차기출상급여익생균제제3.5 g、매일3차,사매일익생균총량위1×109개,련속사용21 d.비교량조간예전급간예4、8、15、21 d청신공복혈당수평、주원기간이도소사용정황、격랍사가혼미평분(GCS)、ICU주원일급28d병사솔.결과 량조환자간예전혈당수평무명현차이,이시험조재간예8d、15d시청신공복혈당수평현저저우대조조(mmol/L.8d:6.6±1.2비8.0±2.7,t=-2.500,P=0.017;15d:6.1±1.4비7.2±2.2,t=-2.269,P=0.028).시험조이도소사용솔급사용이도소천수(d)균명현소우대조조[19.2％(5/26)비46.2％(12/26),x2=4.282,P=0.039;1.6±0.9비4.3±3.1,t=-2.698,P=0.017];시험조ICU주원일명현단우대조조(d:6.8±3.8비10.7±7.3,t=-2.123,P=0.034).시험조화대조조간예전후GCS분치(분,간예전:6.3±1.0비6.4±1.0,t=-0.408,P=0.685;간예21 d:10.1±4.0비9.6±4.3,t=0.435,P=0.665)급28 d병사솔[11.5％(3/26)비19.2％(5/26),x2=0.148,P=0.701]비교차이균무통계학의의.결론 익생균유리우중형로뇌손상환자적혈당공제,단기내재궤제이급대원기예후적영향환수요진일보적연구탐토.
Objective To investigate the effects of probiotics on blood glucose levels and clinical outcomes in patients suffering from severe craniocerebral trauma.Methods A prospective randomized control study was conducted.Fifty-two severe craniocerebral trauma patients admitted to intensive care unit(ICU)were randomized into experimental or control group(each n=26).All patients received conventional treatment according to Guidelines for the Clinical Management of Traumatic Brain Injury and enteral nutrition within 24-48 hours after admission through nasogastric tube.In addition,the experimental group received 1 × 109 bacteria of viable probiotics(Golden Bifid,3.5 g for 3 times per day)per day for 21 days.The fasting blood glucose levels were determined in the morning before intervention and on day 4,8,15,21 after intervention.Amount of insulin used during hospitalization,Glasgow coma scale(GCS)scores,length of ICU stay,and 28-day mortality rate were studied.Results There was no difference in term of the blood glucose levels between two groups before intervention.On day 8 and 15 after intervention,significantly lower levels of fasting blood glucose(mmol/L)were observed in the experimental group compared with those of the control group (8 days:6.6±1.2 vs.8.0±2.7,t=-2.500,P=0.017;15 days:6.1±1.4 vs.7.2±2.2,t=-2.269,P=0.028).There were significantly less patients treated with insulin or shorter days of insulin therapy in experimental group than in control group[19.2％(5/26)vs.46.2％(12/26),x2=4.282,P=0.039;1.6±0.9 vs.4.3±3.1,t=-2.698,P=0.017].The length of ICU stay(days)was significantly shorter in the experimental group than that of control group(6.8±3.8vs.10.7±7.3,t=-2.123,P=0.034).No significant differences were found about the GCS scores(before intervention:6.3±1.0 vs.6.4±1.0,t=-0.408,P=0.685;21 days after intervention:10.1±4.0 vs.9.6 ±4.3,t=0.435,P=0.665)and 28-day mortality rate[11.5％(3/26)vs.19.2％(5/26),x2=0.148,P=0.701]between experimental group and control group.Conclusions Probiotics could facilitate blood glucose control in patients with severe craniocerebral injury.The underlying mechanisms and its long-term efficacy in this category of patients,however,need to be further investigated.
