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目的:研究枯草杆菌二联活菌制剂经鼻饲给药治疗昏迷患者抗生素相关性腹泻的临床疗效。方法:收集以2011年1月至2014年1月本院确诊的76例患抗生素相关性腹泻的昏迷患者作为研究对象,按随机数字表法分为对照组(38例)和试验组(38例),对照组在基础治疗的基础上给予鼻饲蒙脱石散收敛止泻治疗,而试验组在对照组的基础上,同时给予枯草杆菌二联活菌胶囊(美常安)鼻饲给药治疗。对比治疗前后两组患者的症状改善情况以及粪便实验室检查指标,记录两组不良反应。结果:除治疗过程中死亡4例、意识转清停止鼻饲8例外,试验组33例,对照组31例完成试验。试验组治疗有效率明显高于对照组的(X2=2.627,P<0.05)。给药第6d试验组的白细胞转阴率为81.8%,明显高于对照组的30%(P<0.05),给药第6 d及治疗后试验组的肠道菌群纠正率分别为84.2%、94.7%,明显高于对照组的41.2%、64.7%,差异均有统计学意义(P<0.05)。对照组患者不良反应的发生率明显高于试验组(P<0.05)。结论:枯草杆菌二联活菌制剂鼻饲给药可显著改善昏迷患者抗生素相关性腹泻的症状,使肠道菌群更快得以纠正、缓解使肠道炎症,且安全性高,值得临床推广使用。
OBJECTIVE: To study the clinical effect of oral administration of B. subtilis viable nasal feeding on antibiotic-associated diarrhea in coma patients. Methods: A total of 76 comatose patients with antibiotic-associated diarrhea diagnosed in our hospital from January 2011 to January 2014 were collected and divided into control group (38 cases) and experimental group (38 cases) according to random number table ). The control group was given nasal feeding montmorillonite scattered convergence and diarrhea treatment on the basis of basic treatment, while the experimental group was given nasal feeding administration of Bacillus subtilis viable conjugate capsule (Meixuan’an) on the basis of the control group. Before and after treatment, the two groups of patients to improve the symptoms and stool laboratory test indicators, two adverse reactions were recorded. Results: In addition to the treatment of death in 4 cases, consciousness to stop clearing nasal feeding in 8 cases, 33 cases in the test group, 31 cases in the control group to complete the test. The treatment group was significantly higher than the control group (X2 = 2.627, P <0.05). The leukocyte conversion rate was 81.8% on the 6th day in the test group, which was significantly higher than that in the control group (P <0.05). On the 6th day after administration, the correct rate of intestinal flora in the test group was 84.2% , 94.7% respectively, which was significantly higher than that of the control group (41.2%, 64.7%, P <0.05). The incidence of adverse reactions in the control group was significantly higher than that in the experimental group (P <0.05). Conclusion: Nasal feeding administration of Bacillus subtilis bivalent viable preparation can significantly improve antibiotic-associated diarrhea symptoms in patients with coma, make intestinal flora quicker to be corrected, alleviate intestinal inflammation, and have high safety. It is worth to be used clinically.