目的 通过测定食管癌术后患者部分肠道菌群的数量,反映不同抗生素及肠内、肠外营养应用方案对肠道菌群平衡的影响.方法 采用随机数字表法将60例食管癌患者随机分成6组,每组患者在围手术期分别接受6种不同的抗生素及肠内外营养干预方案:抗生素应用3d+术前、术后肠内营养(B组)；抗生素应用3d+术前肠外营养、术后肠内营养(C组)；抗生素应用3d+术前、术后肠外营养(D组)；抗生素应用7d+术前、术后肠内营养(E组)；抗生素应用7d+术前肠外营养、术后肠内营养(F组)；抗生素应用7d+术前、术后肠外营养(G组).采用光冈菌群测定法检测患者术后第1次粪便中拟杆菌、双歧杆菌、乳酸杆菌、肠杆菌及肠球菌数量.以健康成年人作为对照组,比较各组菌群数量及双歧杆菌与肠杆菌比值(B/E值)的差异,并观察术后1个月内患者的并发症发生率.结果 B组双歧杆菌[(10.59±0.39)比(10.88±0.10) lg10n/ml,P=0.186]、乳酸杆菌[(8.59±0.31)比(8.72±0.22) lg10n/ml,P=0.534]、肠杆菌[(8.43±0.50)比(8.67 ±0.24) lg10n/ml,P=0.266]、肠球菌[(7.40±0.61)比(7.78±0.16) lg10n/ml,P=0.111]及B/E值[(1.2589±0.0644)比(1.2560±0.0330),P=0.825]与对照组的差异均无统计学意义.C、D、E、F、G组的拟杆菌[(11.08±0.48),P=0.139; (9.23±0.42),P=0.000; (10.80±0.26),P=0.004; (10.24±0.45),P=0.000；(8.05±0.53),P=0.000比(11.36±0.48) lg10n/ml]、双歧杆菌[(10.19±0.49),P=0.062; (9.00±0.52),P=0.000; (9.31±0.45),P=0.000; (8.47±0.56),P=0.000; (6.99±0.56),P=0.000比(10.59±0.39) lg10n/ml]、乳酸杆菌[(7.99±0.58),P=0.006； (6.84±0.47),P=0.000; (7.72±0.35),P=0.000; (6.93±0.43),P=0.000; (5.93±0.76),P=0.000比(8.59±0.31) lg10n/ml]、肠杆菌[(8.19 ±0.43),P=0.258；(7.93±0.60),P=0.020；(7.47±0.43),P=0.000; (6.90±0.42),P=0.000; (6.58±0.57),P=0.000比(8.43±0.50) lg10n/ml]、肠球菌[(6.90±0.54),P=0.037；(5.89±0.68),P=0.000；(6.20±0.52),P=0.000；(5.91±0.39),P=0.000；(5.14±0.58),P=0.000比(7.40±0.61) lg10n/ml]数量较B组均减少.D及G组B/E值较对照组显著降低(1.1433±0.1350,P=0.025; 1.0706±0.1413,P=0.000比1.2560±0.0330).各组肺部感染(x2=3.647,P=0.601)及吻合口瘘发生率(x2=5.000,P=0.416)的差异均无统计学意义.结论 术前3d及术后积极应用肠内营养有益于肠道微生态平衡；术后长时间应用抗生素易造成菌群失调.
目的 通過測定食管癌術後患者部分腸道菌群的數量,反映不同抗生素及腸內、腸外營養應用方案對腸道菌群平衡的影響.方法 採用隨機數字錶法將60例食管癌患者隨機分成6組,每組患者在圍手術期分彆接受6種不同的抗生素及腸內外營養榦預方案:抗生素應用3d+術前、術後腸內營養(B組)；抗生素應用3d+術前腸外營養、術後腸內營養(C組)；抗生素應用3d+術前、術後腸外營養(D組)；抗生素應用7d+術前、術後腸內營養(E組)；抗生素應用7d+術前腸外營養、術後腸內營養(F組)；抗生素應用7d+術前、術後腸外營養(G組).採用光岡菌群測定法檢測患者術後第1次糞便中擬桿菌、雙歧桿菌、乳痠桿菌、腸桿菌及腸毬菌數量.以健康成年人作為對照組,比較各組菌群數量及雙歧桿菌與腸桿菌比值(B/E值)的差異,併觀察術後1箇月內患者的併髮癥髮生率.結果 B組雙歧桿菌[(10.59±0.39)比(10.88±0.10) lg10n/ml,P=0.186]、乳痠桿菌[(8.59±0.31)比(8.72±0.22) lg10n/ml,P=0.534]、腸桿菌[(8.43±0.50)比(8.67 ±0.24) lg10n/ml,P=0.266]、腸毬菌[(7.40±0.61)比(7.78±0.16) lg10n/ml,P=0.111]及B/E值[(1.2589±0.0644)比(1.2560±0.0330),P=0.825]與對照組的差異均無統計學意義.C、D、E、F、G組的擬桿菌[(11.08±0.48),P=0.139; (9.23±0.42),P=0.000; (10.80±0.26),P=0.004; (10.24±0.45),P=0.000；(8.05±0.53),P=0.000比(11.36±0.48) lg10n/ml]、雙歧桿菌[(10.19±0.49),P=0.062; (9.00±0.52),P=0.000; (9.31±0.45),P=0.000; (8.47±0.56),P=0.000; (6.99±0.56),P=0.000比(10.59±0.39) lg10n/ml]、乳痠桿菌[(7.99±0.58),P=0.006； (6.84±0.47),P=0.000; (7.72±0.35),P=0.000; (6.93±0.43),P=0.000; (5.93±0.76),P=0.000比(8.59±0.31) lg10n/ml]、腸桿菌[(8.19 ±0.43),P=0.258；(7.93±0.60),P=0.020；(7.47±0.43),P=0.000; (6.90±0.42),P=0.000; (6.58±0.57),P=0.000比(8.43±0.50) lg10n/ml]、腸毬菌[(6.90±0.54),P=0.037；(5.89±0.68),P=0.000；(6.20±0.52),P=0.000；(5.91±0.39),P=0.000；(5.14±0.58),P=0.000比(7.40±0.61) lg10n/ml]數量較B組均減少.D及G組B/E值較對照組顯著降低(1.1433±0.1350,P=0.025; 1.0706±0.1413,P=0.000比1.2560±0.0330).各組肺部感染(x2=3.647,P=0.601)及吻閤口瘺髮生率(x2=5.000,P=0.416)的差異均無統計學意義.結論 術前3d及術後積極應用腸內營養有益于腸道微生態平衡；術後長時間應用抗生素易造成菌群失調.
목적 통과측정식관암술후환자부분장도균군적수량,반영불동항생소급장내、장외영양응용방안대장도균군평형적영향.방법 채용수궤수자표법장60례식관암환자수궤분성6조,매조환자재위수술기분별접수6충불동적항생소급장내외영양간예방안:항생소응용3d+술전、술후장내영양(B조)；항생소응용3d+술전장외영양、술후장내영양(C조)；항생소응용3d+술전、술후장외영양(D조)；항생소응용7d+술전、술후장내영양(E조)；항생소응용7d+술전장외영양、술후장내영양(F조)；항생소응용7d+술전、술후장외영양(G조).채용광강균군측정법검측환자술후제1차분편중의간균、쌍기간균、유산간균、장간균급장구균수량.이건강성년인작위대조조,비교각조균군수량급쌍기간균여장간균비치(B/E치)적차이,병관찰술후1개월내환자적병발증발생솔.결과 B조쌍기간균[(10.59±0.39)비(10.88±0.10) lg10n/ml,P=0.186]、유산간균[(8.59±0.31)비(8.72±0.22) lg10n/ml,P=0.534]、장간균[(8.43±0.50)비(8.67 ±0.24) lg10n/ml,P=0.266]、장구균[(7.40±0.61)비(7.78±0.16) lg10n/ml,P=0.111]급B/E치[(1.2589±0.0644)비(1.2560±0.0330),P=0.825]여대조조적차이균무통계학의의.C、D、E、F、G조적의간균[(11.08±0.48),P=0.139; (9.23±0.42),P=0.000; (10.80±0.26),P=0.004; (10.24±0.45),P=0.000；(8.05±0.53),P=0.000비(11.36±0.48) lg10n/ml]、쌍기간균[(10.19±0.49),P=0.062; (9.00±0.52),P=0.000; (9.31±0.45),P=0.000; (8.47±0.56),P=0.000; (6.99±0.56),P=0.000비(10.59±0.39) lg10n/ml]、유산간균[(7.99±0.58),P=0.006； (6.84±0.47),P=0.000; (7.72±0.35),P=0.000; (6.93±0.43),P=0.000; (5.93±0.76),P=0.000비(8.59±0.31) lg10n/ml]、장간균[(8.19 ±0.43),P=0.258；(7.93±0.60),P=0.020；(7.47±0.43),P=0.000; (6.90±0.42),P=0.000; (6.58±0.57),P=0.000비(8.43±0.50) lg10n/ml]、장구균[(6.90±0.54),P=0.037；(5.89±0.68),P=0.000；(6.20±0.52),P=0.000；(5.91±0.39),P=0.000；(5.14±0.58),P=0.000비(7.40±0.61) lg10n/ml]수량교B조균감소.D급G조B/E치교대조조현저강저(1.1433±0.1350,P=0.025; 1.0706±0.1413,P=0.000비1.2560±0.0330).각조폐부감염(x2=3.647,P=0.601)급문합구루발생솔(x2=5.000,P=0.416)적차이균무통계학의의.결론 술전3d급술후적겁응용장내영양유익우장도미생태평형；술후장시간응용항생소역조성균군실조.
Objective To investigate the effects of peri-operative enteral nutrition (EN) and antibiotics on intestinal flora balance in patients with esophageal carcinoma.Methods Sixty patients were randomly divided into six groups:Group B,treated with antibiotics for 3 days and supported with EN before and after operation; Group C,treated with antibiotics for 3 days and supported with parenteral nutrition (PN) before operation and EN after operation ; Group D,treated with antibiotics for 3 days and supported with PN before and after operation ; Group E,treated with antibiotics for 7 days and supported with EN before and after operation; Group F,treated with antibiotics for 7 days and supported with PN before operation and EN after operation ; and Group G,treated with antibiotics for 7 days and supported with PN before and after operation.The first stool after surgery was obtained and tested for Bacteroides,Bifidobacterium,Lactobacillus,Escherichia coli,and Enterococcus.Ten healthy adults were enrolled as the blank control group.The numbers of the flora and ratio of Bifidobacteria to Enterococci (B/E) were compared.Complications such as incision infections,lung infections,and anastomotic fistula were recorded.Results The numbers of Bifidobacterium [(10.59 ± 0.39) vs.(10.88 ± 0.10) lg10n/ml,P =0.186),Lactobacillus [(8.59±0.31) vs.(8.72 ±0.22) lg10n/ml,P=0.534],Escherichia coli [(8.43 ±0.50) vs.(8.67 ±0.24) lg10n/ml,P=0.266],Enterococcus [(7.40 ±0.61) vs.(7.78 ±0.16) lg10n/ml,P =0.111],and B/E value [(1.2589 ± 0.0644) vs.(1.2560 ± 0.0330),P =0.825] in the Group B were not significantly different from the blank control group.The numbers of Bacteroids [(11.08 ± 0.48),P =0.139 ; (9.23 ± 0.42),P =0.000; (10.80±0.26),P=0.004; (10.24±0.45),P=0.000; (8.05±0.53),P=0.000vs.(11.36±0.48) lg10n/ml],Bifidobacterium [(10.19 ±0.49),P=0.062; (9.00 ±0.52),P=0.000; (9.31 ±0.45),P=0.000; (8.47±0.56),P=0.000; (6.99 ±0.56),P =0.000 vs.(10.59±0.39) lg10n/ml],Lactobacillus [(7.99 ± 0.58),P =0.006 ; (6.84 ± 0.47),P =0.000 ; (7.72 ± 0.35),P =0.000 ; (6.93 ±0.43),P =0.000; (5.93 ±0.76),P=0.000 vs.(8.59 ±0.31) lg10n/ml],Escherichia coli [(8.19 ±0.43),P=0.258; (7.93±0.60),P=0.020; (7.47±0.43),P=0.000; (6.90±0.42),P=0.000; (6.58±0.57),P =0.000 vs.(8.43 ± 0.50) lg10n/ml],and Enterococcus [(6.90 ± 0.54),P =0.037 ; (5.89 ± 0.68),P =0.000; (6.20±0.52),P=0.000; (5.91 ±0.39),P=0.000; (5.14±0.58),P=0.000 vs.(7.40±0.61) lg10n/ml] of groups C,D,E,F,and G decreased compared with those of the Group B.The values of B/Ein the D and G groups decreased significantly when compared to the blank control group (1.1433 ±0.1350,P =0.025 ; 1.0706 ± 0.1413,P =0.000 vs.1.2560 ± 0.0330).The incidences of pulmonary infections (x2 =3.647,P =0.601) and anastomotic leak (x2 =5.000,P =0.416) among all groups were not significantly different.Conclusions EN applied 3 days before surgery and after surgery is beneficial for maintaining the balance of intestinal flora.Long-term administration of antibiotics may cause dysbacteriosis and even increase complications.
