双歧杆菌对机械通气新生儿呼吸道和胃肠道的影响

Effects of bifidobacteria on respiratory and gastrointestinal tracts in neonates receiving mechanical ventilation

摘要:

目的：观察双歧杆菌对机械通气新生儿呼吸道和胃肠道的影响。方法：将机械通气新生儿随机分为观察组（n=38）和对照组（n=43），观察组在机械通气后第2天开始鼻饲双歧杆菌1粒/d，连用7 d，对照组不予干预。观察两组胃液pH、胃定植菌、喂养不耐受、体重增加、呼吸机相关性肺炎（VAP）发生比率及病原菌与胃定植菌同源性等情况。结果：观察组第3、5天及第7天胃液pH≤3的比例均明显高于对照组（P0.05）。结论：双歧杆菌可降低胃酸度，减少胃定植菌和喂养不耐受发生，可间接阻断胃-口咽-呼吸道感染途径，从而减少VAP的发生。

Abstract:

OBJECTIVE: To study the effects of bifidobacterium on respiratory and gastrointestinal tracts in neonates receiving mechanical ventilation. METHODS: The eligible neonates were randomly assigned into two groups: observed (n=38) and control (n=43). The observed group was given bifidobacteria daily (one capsule per time, for 7 days) by nasal feeding from the next day after mechanical ventilation. Gastric pH, gastric bacteria colonization, feeding intolerance, weight gain, the incidence of ventilator-associated pneumonia (VAP), and the homology between the bacteria isolated from intra-gastric colonization with those causing VAP were observed. RESULTS: The incidence of gastric pH≤3 in the observed group was significantly higher than that in the control group 3, 5 and 7 days after mechanical ventilation (P＜0.01). The rate of gastric bacteria colonization in the observed group was significantly lower than that in the control group 5 and 7 days after mechanical ventilation (P＜0.01). The incidences of feeding intolerance and VAP in the observed group were significantly lower than those in the control group (P＜0.05, P＜0.01, respectively). The rate of homology of the bacteria isolated from intra-gastric colonization with those causing VAP in the observed group was significantly lower than that in the control group (P＜0.01). There were no significant differences in the weight gain between the two groups. CONCLUSIONS: Bifidobacterium can decrease gastric pH, gastric bacteria colonization and feeding intolerance, thus blocks the infection route "stomach-oropharynx-respiratory tract" indirectly and decreases the incidence of endogenous VAP in neonates receiving mechanical ventilation.