CAJ | 학술논문

目的：探讨益生菌联合乳果糖对重症心脏瓣膜病患者术后腹腔内压（IAP）及胃肠功能、预后的影响。方法2013年8月至2014年8月入选的56例患者并被随机分为两组，各28例。治疗组术后第1天开始使用益生菌联合乳果糖，持续至术后第7天；对照组未使用益生菌及乳果糖，其他治疗同治疗组。通过膀胱测压法测量两组患者术前和术后第1~5天的IAP，记录两组患者术后首次排便时间、ICU停留时间、术后住院时间；记录两组患者术后腹腔高压（IAH）、腹腔间隔综合征（ACS）、胃肠功能障碍及死亡例数。结果治疗组与对照组术前IAP差异无统计学意义[（3.96±1.63）mmHg vs（3.63±1.58） mmHg，t=0.44，P=0.63]，两组术后IAP均呈先上升后下降趋势，治疗组和对照组分别在术后第3、4天达最高点，术后第1天两组HAP水平差异无统计学意义[（11.87±2.22）mmHg vs （11.58±2.76）mmHg，t=1.62，P=0.11]，术后第2天开始差异有统计学意义（术后第2~5天的t值分别为2.24、2.47、4.23、4.92，P值分别为0.04、0.02、0.00、0.00）；两组术后首次排便时间（t=2.36，P=0.03）、ICU停留时间（t=3.87，P=0.00）及术后住院时间（t=2.76， P=0.01）之间差异均有统计学意义；治疗组与对照组术后IAH发生率（14.28%vs 39.28%，χ2=4.46， P=0.04）、胃肠功能障碍发生率（7.14%vs 28.57%，χ2=4.38，P=0.04）方面差异均有统计学意义。结论重症瓣膜病术后早期联合使用益生菌和乳果糖可有效降低IAP，改善胃肠功能，降低ICU停留时间和术后住院时间。
목적：탐토익생균연합유과당대중증심장판막병환자술후복강내압（IAP）급위장공능、예후적영향。방법2013년8월지2014년8월입선적56례환자병피수궤분위량조，각28례。치료조술후제1천개시사용익생균연합유과당，지속지술후제7천；대조조미사용익생균급유과당，기타치료동치료조。통과방광측압법측량량조환자술전화술후제1~5천적IAP，기록량조환자술후수차배편시간、ICU정류시간、술후주원시간；기록량조환자술후복강고압（IAH）、복강간격종합정（ACS）、위장공능장애급사망례수。결과치료조여대조조술전IAP차이무통계학의의[（3.96±1.63）mmHg vs（3.63±1.58） mmHg，t=0.44，P=0.63]，량조술후IAP균정선상승후하강추세，치료조화대조조분별재술후제3、4천체최고점，술후제1천량조HAP수평차이무통계학의의[（11.87±2.22）mmHg vs （11.58±2.76）mmHg，t=1.62，P=0.11]，술후제2천개시차이유통계학의의（술후제2~5천적t치분별위2.24、2.47、4.23、4.92，P치분별위0.04、0.02、0.00、0.00）；량조술후수차배편시간（t=2.36，P=0.03）、ICU정류시간（t=3.87，P=0.00）급술후주원시간（t=2.76， P=0.01）지간차이균유통계학의의；치료조여대조조술후IAH발생솔（14.28%vs 39.28%，χ2=4.46， P=0.04）、위장공능장애발생솔（7.14%vs 28.57%，χ2=4.38，P=0.04）방면차이균유통계학의의。결론중증판막병술후조기연합사용익생균화유과당가유효강저IAP，개선위장공능，강저ICU정류시간화술후주원시간。
Objective To evaluate the effect of intra-abdominal pressure and the change of gastrointestinal function in patients of advanced valvular heart disease using probiotics and lactulose after operation. Methods From August 2013 to August 2014, fifty-six patients were selected and divided into two groups randomly:28 cases in the treatment group, using probiotics and lactulose the first day after operation until the seventh day. The other 28 cases were the control group, undergoing the same procedure except for probiotics and lactulose. IAP was measured preoperatively, the first, second, third, fourth, and fifth day after operation in the two groups through measuring the bladder pressure. Postoperative defecation time for the first time (d), ICU stay time (h), postoperative length of hospital stay (d), incidence of IAH/ACS gastrointestinal dysfunction and mortality in the two groups were also recorded. Results There was no statistically significant difference between the two groups in IAP preoperatively [(3.96±1.63) mmHg vs (3.63±1.58) mmHg, t=0.44, P=0.63] and one day after operation [(11.87±2.22) mmHg vs (11.58±2.76) mmHg, t=1.62, P=0.11]. Postoperative IAP in the two groups increased at first and then decreased, reaching up to the peak at the third day in treatment group and the fourth day in the control group. At the beginning of the second day after operation, the difference was statistically significant (2-5 day after operation, t=2.24, 2.47, 4.23, 4.92, P=0.02, 0.04, 0.00, 0.00). And differences were statistically significant between groups on postoperative defecation for the first time(t=2.36, P=0.03), ICU stay time (t=3.87, P=0.00) , postoperative length of hospital stay (t=2.76, P=0.01), incidence of IAH (14.28%vs 39.28%,χ2=4.46, P=0.04) and gastrointestinal dysfunction (7.14%vs 28.57%,χ2=4.38, P=0.04). Conclusion Use of probiotics and lactulose in advanced valvular disease after operation can effectively reduce IAP, improve gastrointestinal function, and reduce the length of ICU and postoperative hospital stay.