【摘要】 目的探讨阻断新生儿呼吸机相关性肺炎(VAP)胃—肺感染途径的方法,降低VAP发生率。方法将机械通气新生儿随机分为2组,实验组(38例)鼻饲双歧杆菌,对照组(43例)不干预,前瞻性观察2组患儿VAP发生率、胃液pH值、胃细菌定植及其与VAP病原学的同源性等。结果实验组和对照组VAP发生率分别为13.16%(5/38)和46.51%(20/43),两组比较,差异有统计学意义(χ~2=10.52,P<0.01)。实验组VAP发生时间为机械通气第(5.40±2.07)d,晚于对照组的(4.25±1.00)d(t=3.24,P<0.01)。第7天,实验组新生儿胃液pH≤3的比率(84.21%)高于对照组(46.51%)(χ~2=12.47,P<0.01);而胃细菌定植比率(31.58%)低于对照组(74.42%)(χ~2=14.92,P<0.01)。实验组VAP病原菌与胃定植菌同源率(40.00%)低于对照组(75.00%)(χ~2=8.00,P<0.01)。对VAP危险因素进行单因素分析,使用双歧杆菌及胃液pH≤3是保护因素,胃内细菌定植是危险因素,OR值及95%CI均有统计学意义。结论双歧杆菌能降低新生儿胃液pH值,抑制胃内细菌定植,延迟VAP发生时间,有效降低早发性VAP的发生率。更多还原

【Abstract】 Objective To explore the method that can block the infection route from stomach to lung so as to reduce the incidence of ventilator-associated pneumonia(VAP) in neonates.Methods Neonates with mechanical ventilation were randomly divided into two groups,the experimental group(38 cases) were given Bifidobacteria by nasogastric feeding,control group(43 cases) were given nothing,prospective survey was performed on the incidence of VAP,gastric juice PH,gastric bacterial colonization,the homology between gastric bacterial colonization and VAP pathogen.Results The VAP incidence of experimental group and control group was 13.16%(5/38) and 46.51% (20/43) respectively,there was significant difference between two groups(x~2= 10.52,P<0.01).The onset time of VAP in experimental group(5.4±2.07d)was later than that of control group(4.25±1.00d)(t = 3.24,P<0.01). The ratio of experimental group that gastric juice dropped to pH≤3 was higher than that of control group (46.51%)(x~2 = 12.47,P<0.01);and the ratio of gastric bacterial colonization in experimental group(31.58%) was lower than that in control group(74.42%)(x~2 = 14.42,P<0.01).The homology ratio between VAP pathogen and colonization bacteria in experimental group(40.00%) was lower than that in control group(75.00%)(x~2= 8.00,P<0.01).The univariate analysis of risk factors showed that Bifidobacterium use and gastric bacteria juice PH≤3 were protective factors,but gastric bacterial colonization was the risk factor.OR and 95%CI were statistically significant.Conclusion Bifidobacterium can reduce gastric juice PH of neonates and inhibit gastric bacterial colonization.The onset time of VAP can be delayed,the incidence of early-onset of VAP can be reduced effectively.更多还原