方勤

【摘要】 目的 探讨益生菌对多发伤患者腹泻发生率的影响及对已发生腹泻患者的治疗效果。方法 320例入住ICU的多发伤患者， 随机分为治疗组183例与对照组137例。对照组给予常规综合治疗， 治疗组在综合治疗基础上加用蜡样芽孢杆菌治疗。观察两组治疗5 d后腹泻发生情况， 对照组患者治疗5 d未出院的腹泻患者给予不同治疗， 随机分为蒙脱石散组、蜡样芽孢杆菌组、蒙脱石散+蜡样芽孢杆菌组（联合治疗组）， 观察各组的治疗效果。结果 治疗5 d后， 治疗组腹泻指数优于对照组， 差异具有统计学意义（P<0.05）。治疗5 d后， 治疗组总腹泻率21.9%低于对照组46.7%， 差异具有统计学意义（P<0.05）。对照组治疗5 d后未出院的腹泻患者80例， 蒙脱石散组26例患者经治疗总有效率为69.2%， 蜡样芽孢杆菌组28例患者经治疗总有效率为64.3%， 联合治疗组26例患者经治疗总有效率为92.3%， 联合治疗组总有效率高于蒙脱石散组及蜡样芽孢杆菌组， 差异均具有统计学意义（P<0.05）， 蒙脱石散组与蜡样芽孢杆菌组总有效率比较差异无统计学意义（P>0.05）。结论 在综合治疗基础上加用蜡样芽孢杆菌能有效防止多发伤患者腹泻发生， 联合使用蜡样芽孢杆菌及蒙脱石散治疗腹泻较单药使用效果好。

【关键词】 蜡样芽孢杆菌；多发伤；腹泻

DOI：10.14163/j.cnki.11-5547/r.2016.22.003

Clinical observation of influence by bacillus cereus on diarrhea in ICU patients with multiple injuries FANG Qin. Department of Intensive Medicine， Luohe City Central Hospital， Luohe 462300， China

【Abstract】 Objective To investigate influence by probiotics on incidence of diarrhea in patients with multiple injuries and its curative effect for diarrhea. Methods A total of 320 ICU patients with multiple injuries were randomly divided into treatment group with 183 cases and control group with 137 cases. The control group received conventional comprehensive therapy， and the treatment group received additional bacillus cereus for treatment. Observation was made on diarrhea condition after 5 d of treatment in both groups. Patients in the control group， who were not discharged， received different treatment measures. They were randomly divided into montmorillonite powder group， bacillus cereus group and montmorillonite powder + bacillus cereus group （combined treatment group）， and curative effects were observed in all groups. Results After 5 d of treatment， the treatment group had better diarrhea index than the control group， and their difference had statistical significance （P<0.05）. The treatment group had lower total diarrhea rate as 21.9% after 5 d of treatment than 46.7% in the control group， and their difference had statistical significance （P<0.05）. There were 80 left cases in the control group after 5 d of treatment. The montmorillonite powder group with 26 cases had total effective rate as 69.2%， the bacillus cereus group with 28 cases had total effective rate as 64.3%， and the combined treatment group with 26 cases had total effective rate as 92.3%. The combined treatment group had higher total effective rate than the montmorillonite powder group and the bacillus cereus group. Their differences all had statistical significance （P<0.05）. There was no statistically significant difference of total effective rate between the montmorillonite powder group and the bacillus cereus group （P>0.05）. Conclusion Additional implement of bacillus cereus to comprehensive therapy can effective prevent diarrhea in patients with multiple injuries. Combination of bacillus cereus and montmorillonite powder provides better effect than single drug therapy in treating diarrhea.

【Key words】 Bacillus cereus； Multiple injuries； Diarrhea

多发伤是指机体在单一机械损伤因素作用下， 同时或相继遭受两个或两个以上解剖部位的损伤， 其中之一即使单独存在创伤也可能危及生命或肢体。多发伤损伤机制复杂， 不同受累器官之间相互影响， 加重损伤反应， 且病情变化快， 合并症发生率较高， 此类患者入院后往往进入ICU进行综合治疗[1]。而腹泻是ICU患者的一个常见并发症， 腹泻加重了患者的病情， 延误病程， 增加患者在ICU住院天数， 增加了患者的经济负担。入住ICU多发伤患者腹泻可能有以下几种原因：不适当的肠内营养、肠道感染、广谱抗生素应用、胃肠动力性药物应用、机械通气等。益生菌是定植于人体肠壁黏膜上皮， 能产生较确切健康功效的有益的活的微生物的总体。……