凝结芽孢杆菌活菌片联合蒙脱石散治疗腹腔镜胆囊切除术后腹泻的临床观察
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摘要
目的观察凝结芽孢杆菌活菌片联合蒙脱石散治疗腹腔镜胆囊切除术后腹泻的疗效及对肠道菌群和肠道屏障功能的影响。方法将2014年5月—2018年6月期间宁波大学医学院附属鄞州医院收治的120例腹腔镜胆囊切除术后腹泻患者按随机数字表法分为观察组60例和对照组60例,对照组给予蒙脱石散治疗,观察组在对照组治疗基础上给予凝结芽孢杆菌活菌片治疗,均治疗2周。观察2组治疗前后主要临床症状积分、肠道菌群及肠道黏膜屏障功能的变化。结果 2组患者治疗后,大便次数、大便性状以及腹部不适症状有不同程度的好转,观察组的总有效率为91.7%(55/60),对照组为71.7%(43/60),观察组疗效比对照组更显著(χ~2=9.186,P=0.010)。治疗后,观察组大肠埃希菌和肠球菌与治疗前相比显著下降(P<0.05),且低于对照组,差异有统计学意义(P<0.05);观察组乳酸杆菌、双歧杆菌数量显著升高(P<0.05),且显著高于对照组(P<0.05)。治疗后,2组血清D-乳酸指标较治疗前明显下降,观察组下降幅度较对照组高,差异有统计学意义(P<0.05)。2组治疗后肠道sIgA水平均显著高于治疗前(P<0.05),且观察组治疗后肠道sIgA水平显著高于对照组(P<0.05)。结论凝结芽孢杆菌活菌片联合蒙脱石散可显著缓解腹腔镜胆囊切除术后腹泻患者临床症状,其机制可能与调节患者肠道微生态平衡以及促进肠道黏膜上皮细胞屏障功能的恢复有关。
Objective To observe the effect of Bacillus coagulans live tablets combined with Smectite powder treatment after laparoscopic cholecystectomy diarrhea and effect on intestinal microflora and intestinal barrier function. Methods One hundred and twenty patients of laparoscopic cholecystectomy with diarrhea were randomly divided into observation group 60 cases and control group 60 cases from May 2014 to June 2018, control group was given smectite powder, the observation group was treated with Bacillus coagulans live tablets, 2 groups were treated for two weeks. The changes of total clinical symptom scores, intestinal flora and intestinal mucosal barrier function were observed before and after treatment. Results The stool frequency, stool and abdominal discomfort symptoms of two groups improved after treatment, the total effective rate of observation group was 91.7%(55/60), the control group was 71.7%(43/60), the efficacy of the observation group was more significant than the control group(χ~2=9.186, P=0.010). After treatment, the Escherichia coli and enterococci in the observation group decreased significantly compared with those before treatment(P<0.05), and significantly lower than those in the control group(P<0.05). The number of Lactobacillus and Bifidobacteria in the observation group increased significantly(P<0.05), and significantly higher than that in the control group(P<0.05). After treatment, the serum D-lactate index in the two groups was significantly lower than that before the treatment, and the decrease in the observation group was more obvious than that in the control group(P<0.05). The level of sIgA in the two groups was significantly higher than that before treatment(P<0.05), and the sIgA level of the intestinal tract in the observation group was significantly higher than that of the control group(P<0.05). Conclusion Bacillus coagulans live tablets combined with Smectite powder treatment can significantly relieve the clinical symptoms after laparoscopic cholecystectomy in patients with diarrhea, which may be related to its regulation in patients with intestinal microecological balance and promote the epithelial barrier function of intestinal mucosa repair.
Objective To observe the effect of Bacillus coagulans live tablets combined with Smectite powder treatment after laparoscopic cholecystectomy diarrhea and effect on intestinal microflora and intestinal barrier function. Methods One hundred and twenty patients of laparoscopic cholecystectomy with diarrhea were randomly divided into observation group 60 cases and control group 60 cases from May 2014 to June 2018, control group was given smectite powder, the observation group was treated with Bacillus coagulans live tablets, 2 groups were treated for two weeks. The changes of total clinical symptom scores, intestinal flora and intestinal mucosal barrier function were observed before and after treatment. Results The stool frequency, stool and abdominal discomfort symptoms of two groups improved after treatment, the total effective rate of observation group was 91.7%(55/60), the control group was 71.7%(43/60), the efficacy of the observation group was more significant than the control group(χ~2=9.186, P=0.010). After treatment, the Escherichia coli and enterococci in the observation group decreased significantly compared with those before treatment(P<0.05), and significantly lower than those in the control group(P<0.05). The number of Lactobacillus and Bifidobacteria in the observation group increased significantly(P<0.05), and significantly higher than that in the control group(P<0.05). After treatment, the serum D-lactate index in the two groups was significantly lower than that before the treatment, and the decrease in the observation group was more obvious than that in the control group(P<0.05). The level of sIgA in the two groups was significantly higher than that before treatment(P<0.05), and the sIgA level of the intestinal tract in the observation group was significantly higher than that of the control group(P<0.05). Conclusion Bacillus coagulans live tablets combined with Smectite powder treatment can significantly relieve the clinical symptoms after laparoscopic cholecystectomy in patients with diarrhea, which may be related to its regulation in patients with intestinal microecological balance and promote the epithelial barrier function of intestinal mucosa repair.
引文
[1] 凤利锋,田阳涛,刘爱军.腹腔镜胆囊切除术中胆管损伤原因及防治分析[J].陕西医学杂志,2017,46(3):377-378.
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[3] 习意平.双歧杆菌四联活菌片对胆囊切除术后腹泻患者肠道微生态及胃肠激素的影响[J].中国微生态学杂志,2018,30(6):717-720.
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[5] 李明.酪酸梭菌散剂联合应用蒙脱石散治疗小儿急性腹泻临床疗效观察[J].实用临床医药杂志,2014,18(21):150-151.
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[7] 姜先敏,蒋志慧,郭立明,等.113例外科手术后腹泻患儿经2种药物治疗的临床对比研究[J].中华全科医学,2015,13(11):1815-1817.
[8] 冯健,崔乃强,蔡旺,等.胆囊切除术后综合征的诊疗现状[J].中国中西医结合外科杂志,2018,24(2):252-255.
[9] 张梦,孟涛,成芳,等.胆囊疾病与大肠癌发生的关联性分析[J].中华肿瘤防治杂志,2016,23(4):258-261.
[10] 冯其贞,李建军.胆囊切除术后腹泻相关因素研究进展[J].济宁医学院学报,2015,38(2):142-144,148.
[11] 朱剑南,胆囊切除术后腹泻患者应用双歧三联活菌胶囊改善其肠道微生态紊乱的效果评价[J].中国微生态学杂志,2017,29(5):567-569,580.
[12] 李铁,刘平,及东林.参苓白术散联合盐酸洛哌丁胺胶囊治疗腹腔镜胆囊切除术后腹泻疗效及对肠道菌群及胃肠激素的影响[J].现代中西医结合杂志,2017,26(19):2097-2101.
[13] 王梦华.双歧杆菌三联活菌胶囊对胆囊切除术后腹泻患者肠道菌群及sIgA水平的影响[J].中国微生态学杂志,2014,26(10):1166-1168.
[14] 娄朝胜,双歧三联活菌胶囊对胆囊切除术后腹泻患者血清D-乳酸及肠道菌群的影响[J].中国微生态学杂志,2015,27(12):1424-1426,1430.
[15] 张丽霞,沈华祥,曹云飞,等.小麦纤维素颗粒联合凝结芽孢杆菌活菌片治疗晚期妊娠便秘的临床观察[J].中国微生态学杂志,2016,28(11):1333-1336.
[16] 吉训恋.氟哌噻吨美利曲辛用于腹泻型肠易激综合征患者效果观察[J].山东医药,2015,55(10):66-67.
[17] 叶翠青.凝结芽孢杆菌活菌片治疗婴儿湿疹48例疗效观察[J].中国实用医药,2017,12(18):120-121.
[18] 秦爱华,王亚男,李月芹,等.凝结芽孢杆菌活菌片治疗孕妇功能性腹胀的临床疗效[J].中国微生态学杂志,2016,28(4):472-474.
[19] 苏连明,朱雯,王程程,等.凝结芽孢杆菌对急性重症胰腺炎患者血清炎症因子水平的影响[J].中华实用诊断与治疗杂志,2015,29(2):201-203.
[20] 李妮芝.消旋卡多曲联合蒙脱石散治疗小儿轮状病毒肠炎的临床分析[J].陕西医学杂志,2014,43(12):1665-1666.
[21] 羊慧丹.蒙脱石散联合常乐康治疗小儿轮状病毒肠炎的临床疗效观察[J].中国妇幼保健,2018,33(9):2019-2020.
[2] 汤朝晖,耿智敏,锁涛,等.胆囊切除术后常见并发症的诊断与治疗专家共识(2018版)[J].全科医学临床与教育,2018,16(3):244-246.
[3] 习意平.双歧杆菌四联活菌片对胆囊切除术后腹泻患者肠道微生态及胃肠激素的影响[J].中国微生态学杂志,2018,30(6):717-720.
[4] URGESI R, CASALE C, PISTELLI R,et al.A randomized double-blind placebo-controlled clinical trial on efficacy and safety of association of simethicone and Bacillus coagulans (Colinox?) in patients with irritable bowel syndrome[J].Eur Rev Med Pharmacol Sci,2014,18(9):1344-1353.
[5] 李明.酪酸梭菌散剂联合应用蒙脱石散治疗小儿急性腹泻临床疗效观察[J].实用临床医药杂志,2014,18(21):150-151.
[6] 林果为,王吉耀,葛均波.实用内科学[M].15版.北京:人民卫生出版社,2017:1483-1487.
[7] 姜先敏,蒋志慧,郭立明,等.113例外科手术后腹泻患儿经2种药物治疗的临床对比研究[J].中华全科医学,2015,13(11):1815-1817.
[8] 冯健,崔乃强,蔡旺,等.胆囊切除术后综合征的诊疗现状[J].中国中西医结合外科杂志,2018,24(2):252-255.
[9] 张梦,孟涛,成芳,等.胆囊疾病与大肠癌发生的关联性分析[J].中华肿瘤防治杂志,2016,23(4):258-261.
[10] 冯其贞,李建军.胆囊切除术后腹泻相关因素研究进展[J].济宁医学院学报,2015,38(2):142-144,148.
[11] 朱剑南,胆囊切除术后腹泻患者应用双歧三联活菌胶囊改善其肠道微生态紊乱的效果评价[J].中国微生态学杂志,2017,29(5):567-569,580.
[12] 李铁,刘平,及东林.参苓白术散联合盐酸洛哌丁胺胶囊治疗腹腔镜胆囊切除术后腹泻疗效及对肠道菌群及胃肠激素的影响[J].现代中西医结合杂志,2017,26(19):2097-2101.
[13] 王梦华.双歧杆菌三联活菌胶囊对胆囊切除术后腹泻患者肠道菌群及sIgA水平的影响[J].中国微生态学杂志,2014,26(10):1166-1168.
[14] 娄朝胜,双歧三联活菌胶囊对胆囊切除术后腹泻患者血清D-乳酸及肠道菌群的影响[J].中国微生态学杂志,2015,27(12):1424-1426,1430.
[15] 张丽霞,沈华祥,曹云飞,等.小麦纤维素颗粒联合凝结芽孢杆菌活菌片治疗晚期妊娠便秘的临床观察[J].中国微生态学杂志,2016,28(11):1333-1336.
[16] 吉训恋.氟哌噻吨美利曲辛用于腹泻型肠易激综合征患者效果观察[J].山东医药,2015,55(10):66-67.
[17] 叶翠青.凝结芽孢杆菌活菌片治疗婴儿湿疹48例疗效观察[J].中国实用医药,2017,12(18):120-121.
[18] 秦爱华,王亚男,李月芹,等.凝结芽孢杆菌活菌片治疗孕妇功能性腹胀的临床疗效[J].中国微生态学杂志,2016,28(4):472-474.
[19] 苏连明,朱雯,王程程,等.凝结芽孢杆菌对急性重症胰腺炎患者血清炎症因子水平的影响[J].中华实用诊断与治疗杂志,2015,29(2):201-203.
[20] 李妮芝.消旋卡多曲联合蒙脱石散治疗小儿轮状病毒肠炎的临床分析[J].陕西医学杂志,2014,43(12):1665-1666.
[21] 羊慧丹.蒙脱石散联合常乐康治疗小儿轮状病毒肠炎的临床疗效观察[J].中国妇幼保健,2018,33(9):2019-2020.