目的 探讨微生态制剂金双歧对腰椎后路手术患者肠道菌群的影响.方法 72例腰椎后路手术患者,出现肠道菌群失调症者42例作为实验组(A组),未出现肠道菌群失调症的30例作为对照组(B组).两组患者术前、术后检测血浆内毒素、血清肿瘤坏死因子α(TNF-α)及白细胞介素6(IL-6).肠道菌群失调症者术后另加用金双歧.术前、术后第1次自然排便(术后1x4d)时分别留取粪便标本,比较两组患者肠道主要菌群差异、双歧杆菌(B)/肠杆菌(E)值.结果 术前、术后第2、7天A、B两组患者血浆内毒素水平分别为(1.82 ±0.12)、(2.29 ±0.15)、(1.91 ±0.08) ng/L和(1.91±0.21)、(2.35±0.16)、(2、26±0.24) ng/L.TNF-α分别为(275±51)、(309 ±45)、(276±34) ng/L和(269±48)、(318±67)、(297±53)ng/L;IL-6分别为(138±22)、(159±15)、(137±17)ng/L和(159±16)、(187±19)、(174±21) ng/L.经重复测量方差分析显示,血浆内毒素、TNF-α、IL-6 3个指标组间、交互作用差异均有统计学意义(P均＜0.05),组内比较差异无统计学意义(P均＞0.05).3个指标浓度均随着住院时间的延长而逐渐降低,术后第2、7天与术前比较差异均有统计学意义(P均＜0.05),且术后第7天与术后第2天比较差异也有统计学意义(P均＜0.05).术后第2天A组血浆内毒素、TNF-α、IL-6与B组比较差异均有统计学意义(P均＜0.05);术后第7天,A组内毒素、TNF-α、IL-6开始缓慢下降,与B组比较差异均有统计学意义(P均＜0.05).术后A组肠道的双歧杆菌、类杆菌数量及B/E值较B组均减少,分别为(9.17±0.54) lg cfu/g与(10.01±0.75) lg cfu/g,(9.23±0.47) lg cfu/g与(10.09±0.81)lg cfu/g,1.01 ±0.16与1.20±0.11,差异均有统计学意义(P值分别为0.031、0.042、0.029);而肠杆菌、肠球菌数量较B组增加,分别为(9.11±1.02) lg cfu/g与(8.81±0.89) lg cfu/g,(7.80±1.02) lg cfu/g与(7.29±0.98) lg cfu/g,差异均有统计学意义(P值分别为0.037、0.043);小梭菌、乳杆菌与B组比较差异均无统计学意义(P均＞0.05).A组使用金双歧后与使用前比较均增加,差异均有统计学意义[双歧杆菌:(13.01±0.87) lg cfu/g与(9.17±0.54) lg cfu/g、类杆菌数量:(14.12±0.75) lg cfu/g与(9.23±0.47) lg cfu/g及B/E值:1.28±0.45与1.01±0.16,P值分别为0.045、0.034、0.038];肠杆菌、肠球菌、小梭菌、乳杆菌数量无明显变化,分别为(8.71±0.91) lg cfu/g与(9.11±1.02) lg cfu/g,(7.01±0.54) lg cfu/g与(7.80±1.02) lg cfu/g,(5.23±1.04) lg cfu/g与(5.15±0.89) lg cfu/g,(6.71±1.04) lg cfu/g与(6.53±0.86) lg cfu/g,差异均无统计学意义(P均＞0.05).结论 腰椎后路手术出现肠道菌群失调的患者常合并内毒素血症及炎症反应,肠道内双歧杆菌、类杆菌数量减少,肠杆菌、肠球菌等条件致病菌数量相对增加,肠道微生物定植抗力下降.补充微生态制剂金双歧能缓解机体的内毒素血症及炎症反应,改善腰椎后路手术后肠道菌群失调,有利于术后重建肠道内微生态的平衡.
目的 探討微生態製劑金雙歧對腰椎後路手術患者腸道菌群的影響.方法 72例腰椎後路手術患者,齣現腸道菌群失調癥者42例作為實驗組(A組),未齣現腸道菌群失調癥的30例作為對照組(B組).兩組患者術前、術後檢測血漿內毒素、血清腫瘤壞死因子α(TNF-α)及白細胞介素6(IL-6).腸道菌群失調癥者術後另加用金雙歧.術前、術後第1次自然排便(術後1x4d)時分彆留取糞便標本,比較兩組患者腸道主要菌群差異、雙歧桿菌(B)/腸桿菌(E)值.結果 術前、術後第2、7天A、B兩組患者血漿內毒素水平分彆為(1.82 ±0.12)、(2.29 ±0.15)、(1.91 ±0.08) ng/L和(1.91±0.21)、(2.35±0.16)、(2、26±0.24) ng/L.TNF-α分彆為(275±51)、(309 ±45)、(276±34) ng/L和(269±48)、(318±67)、(297±53)ng/L;IL-6分彆為(138±22)、(159±15)、(137±17)ng/L和(159±16)、(187±19)、(174±21) ng/L.經重複測量方差分析顯示,血漿內毒素、TNF-α、IL-6 3箇指標組間、交互作用差異均有統計學意義(P均＜0.05),組內比較差異無統計學意義(P均＞0.05).3箇指標濃度均隨著住院時間的延長而逐漸降低,術後第2、7天與術前比較差異均有統計學意義(P均＜0.05),且術後第7天與術後第2天比較差異也有統計學意義(P均＜0.05).術後第2天A組血漿內毒素、TNF-α、IL-6與B組比較差異均有統計學意義(P均＜0.05);術後第7天,A組內毒素、TNF-α、IL-6開始緩慢下降,與B組比較差異均有統計學意義(P均＜0.05).術後A組腸道的雙歧桿菌、類桿菌數量及B/E值較B組均減少,分彆為(9.17±0.54) lg cfu/g與(10.01±0.75) lg cfu/g,(9.23±0.47) lg cfu/g與(10.09±0.81)lg cfu/g,1.01 ±0.16與1.20±0.11,差異均有統計學意義(P值分彆為0.031、0.042、0.029);而腸桿菌、腸毬菌數量較B組增加,分彆為(9.11±1.02) lg cfu/g與(8.81±0.89) lg cfu/g,(7.80±1.02) lg cfu/g與(7.29±0.98) lg cfu/g,差異均有統計學意義(P值分彆為0.037、0.043);小梭菌、乳桿菌與B組比較差異均無統計學意義(P均＞0.05).A組使用金雙歧後與使用前比較均增加,差異均有統計學意義[雙歧桿菌:(13.01±0.87) lg cfu/g與(9.17±0.54) lg cfu/g、類桿菌數量:(14.12±0.75) lg cfu/g與(9.23±0.47) lg cfu/g及B/E值:1.28±0.45與1.01±0.16,P值分彆為0.045、0.034、0.038];腸桿菌、腸毬菌、小梭菌、乳桿菌數量無明顯變化,分彆為(8.71±0.91) lg cfu/g與(9.11±1.02) lg cfu/g,(7.01±0.54) lg cfu/g與(7.80±1.02) lg cfu/g,(5.23±1.04) lg cfu/g與(5.15±0.89) lg cfu/g,(6.71±1.04) lg cfu/g與(6.53±0.86) lg cfu/g,差異均無統計學意義(P均＞0.05).結論 腰椎後路手術齣現腸道菌群失調的患者常閤併內毒素血癥及炎癥反應,腸道內雙歧桿菌、類桿菌數量減少,腸桿菌、腸毬菌等條件緻病菌數量相對增加,腸道微生物定植抗力下降.補充微生態製劑金雙歧能緩解機體的內毒素血癥及炎癥反應,改善腰椎後路手術後腸道菌群失調,有利于術後重建腸道內微生態的平衡.
목적 탐토미생태제제금쌍기대요추후로수술환자장도균군적영향.방법 72례요추후로수술환자,출현장도균군실조증자42례작위실험조(A조),미출현장도균군실조증적30례작위대조조(B조).량조환자술전、술후검측혈장내독소、혈청종류배사인자α(TNF-α)급백세포개소6(IL-6).장도균군실조증자술후령가용금쌍기.술전、술후제1차자연배편(술후1x4d)시분별류취분편표본,비교량조환자장도주요균군차이、쌍기간균(B)/장간균(E)치.결과 술전、술후제2、7천A、B량조환자혈장내독소수평분별위(1.82 ±0.12)、(2.29 ±0.15)、(1.91 ±0.08) ng/L화(1.91±0.21)、(2.35±0.16)、(2、26±0.24) ng/L.TNF-α분별위(275±51)、(309 ±45)、(276±34) ng/L화(269±48)、(318±67)、(297±53)ng/L;IL-6분별위(138±22)、(159±15)、(137±17)ng/L화(159±16)、(187±19)、(174±21) ng/L.경중복측량방차분석현시,혈장내독소、TNF-α、IL-6 3개지표조간、교호작용차이균유통계학의의(P균＜0.05),조내비교차이무통계학의의(P균＞0.05).3개지표농도균수착주원시간적연장이축점강저,술후제2、7천여술전비교차이균유통계학의의(P균＜0.05),차술후제7천여술후제2천비교차이야유통계학의의(P균＜0.05).술후제2천A조혈장내독소、TNF-α、IL-6여B조비교차이균유통계학의의(P균＜0.05);술후제7천,A조내독소、TNF-α、IL-6개시완만하강,여B조비교차이균유통계학의의(P균＜0.05).술후A조장도적쌍기간균、류간균수량급B/E치교B조균감소,분별위(9.17±0.54) lg cfu/g여(10.01±0.75) lg cfu/g,(9.23±0.47) lg cfu/g여(10.09±0.81)lg cfu/g,1.01 ±0.16여1.20±0.11,차이균유통계학의의(P치분별위0.031、0.042、0.029);이장간균、장구균수량교B조증가,분별위(9.11±1.02) lg cfu/g여(8.81±0.89) lg cfu/g,(7.80±1.02) lg cfu/g여(7.29±0.98) lg cfu/g,차이균유통계학의의(P치분별위0.037、0.043);소사균、유간균여B조비교차이균무통계학의의(P균＞0.05).A조사용금쌍기후여사용전비교균증가,차이균유통계학의의[쌍기간균:(13.01±0.87) lg cfu/g여(9.17±0.54) lg cfu/g、류간균수량:(14.12±0.75) lg cfu/g여(9.23±0.47) lg cfu/g급B/E치:1.28±0.45여1.01±0.16,P치분별위0.045、0.034、0.038];장간균、장구균、소사균、유간균수량무명현변화,분별위(8.71±0.91) lg cfu/g여(9.11±1.02) lg cfu/g,(7.01±0.54) lg cfu/g여(7.80±1.02) lg cfu/g,(5.23±1.04) lg cfu/g여(5.15±0.89) lg cfu/g,(6.71±1.04) lg cfu/g여(6.53±0.86) lg cfu/g,차이균무통계학의의(P균＞0.05).결론 요추후로수술출현장도균군실조적환자상합병내독소혈증급염증반응,장도내쌍기간균、류간균수량감소,장간균、장구균등조건치병균수량상대증가,장도미생물정식항력하강.보충미생태제제금쌍기능완해궤체적내독소혈증급염증반응,개선요추후로수술후장도균군실조,유리우술후중건장도내미생태적평형.
Objective To investigate the effect of micro-ecological agent on the intestinal flora of patients with posterior lumbar spine surgery.Methods Seventy-two patients with lumbar spine surgery were selected as our subjects.Of them,42 patients with occurred the intestinal flora dysfunction were served as experimental group (group A),other 30 patients were as control group (group B).The levels of plasma endotoxin,plasma tumor necrosis factor-α (TNF-α),Interleukin 6 (IL-6) were detected before and after operation.The patients in group A were treated with micro-ecological agent Jinshuangqi.Collected stool samples at preoperative,postoperative first natural defecation (after 1-4 d),and compared intestinal flora difference and Bifidobacterium (B)/Enterobacteriaceae (E) value of two groups patients.Results The levels of plasma endotoxin in group A were (1.82 ±0.12),(2.29 ±0.15),(1.91 ±0.08) ng/L at before surgery,the 2nd and 7th day after surgery,and that in group B were(1.91 ±0.21),(2.35 ±0.16),(2.26 ±0.24) ng/L The TNF-α level in group A were (275 ±51),(309 ±45),(276 ±34) ng/L and that in group B were (269 ±48),(318±67),(297 ±53) ng/L at before surgery,the 2nd and 7th day after surgery.The IL-6 levels in group A were (138 ± 22),(159 ± 15),(137 ± 17) ng/L and that in group B were (159 ± 16),(187 ± 19),(174 ± 21) ng/Lat before surgery,the 2nd and 7th day after surgery.The repeated measured repeated measures analysis of variance showed that among three indexes of plasma endotoxin,TNF-α,IL-6 levels,differences of between group and interaction were statistically significant (P ＜ 0.05),but there was no significant difference within groups (P＞ 0.05).The levels of plasma endotoxin,TNF-α,IL-6 decreased after surgery ware gradually decreasing with hospitalization prolonged.There was significant difference between before surgery and at the 2nd,7th day after surgery(P ＜ 0.05),and there was significant difference between the 2nd and the 7th day after surgery(P＜ 0.05).At the 2nd day after surgery,there was significant difference between group A and group B in terms of the level of plasma endotoxin,TNF-α,IL-6.At the 7th day,the levels of plasma endotoxin,TNF-α,IL-6 were slowly decreased in group A,and there were significant difference compared to group B (P ＜ 0.05).The numbers of intestinal Bifidobacterium,Bacteroides,and B/E values of group A were decreased after surgery compared to group B((9.17 ±0.54) lg cfu/g vs.(10.01 ± 0.75) lg cfu/g,(9.23 ± 0.47) lg cfu/g vs.(10.09 ± 0.81)lg cfu/g,(1.01 ± 0.16) vs.(1.20 ± 0.11)),and the difference was significant (P =0.031,0.042,0.029respectively).The levels of Enterobacter and Enterococcus in group A were (9.11 ± 1.02) lg cfu/g,(7.80± 1.02) lg cfu/g,higher than that of group B ((8.81 ± 0.89) lg cfu/g,(7.29 ± 0.98) lg cfu/g(P =0.037,0.043)).There was no significant difference between two groups in terms of small clostridium and lactobacillus (P ＞ 0.05).After treated with micro-ecological agent Jinshuangqi,the levels of intestinal Bifidobacterium,Bacteroides,and B/E value at was increased compared to before treated in group A (Bifidobacterium:(13.01±0.87) lg cfu/g vs.(9.17 ±0.54) lg cfu/g; Bacteroides:(14.12 ±0.75) lg cfu/g vs.(9.23 ±0.47)lg cfu/g; B/E value:(1.28 ± 0.45) vs.(1.01 ± 0.16) ;P =0.045,0.034,0.038 respectively).No significant difference was seen in terms of the levels of Enterobacter,Enterococcus,small clostridium and lactobacillus between two groups(8.71 ±0.91) lg cfu/g vs.(9.11 ± 1.02) lg cfu/g,(7.01 ±0.54) lg cfu/g vs.(7.80± 1.02) lg cfu/g,(5.23 ± 1.04) lg cfu/g vs.(5.15 ± 0.89) lg cfu/g,(6.71 ± 1.04) lg cfu/g vs.(6.53± 0.86) lg cfu/g respectively; P ＞ 0.05).Conclusion Posterior lumbar operation patients with intestinal dysbacteriosis often associated with endotoxemia and inflammatory reaction,the levels of bifidobacteria,Bacteroides intestinal Enterobacteriaceae decrease while Enterococcus,opportunistic pathogens increase,and intestinal microbial colonization resistance decrease.Micro-ecological agent Jinshuangqi treatment can ease the body's endotoxemia and inflammatory response,improved lumbar surgery intestinal flora after surgery,and beneficial to rebuild the intestinal microflora balance.
