益生菌治疗对烧伤患者的临床价值

　　益生菌通常被认为有利于恢复重症患者使用抗生素后的肠道菌群紊乱，有小样本研究表明，益生菌可降低烧伤儿童真菌感染发生率，改善胃肠道症状，缩短创面愈合时间。

　　美国德克萨斯理工大学健康科学中心入组98例烧伤患者进行回顾性队列研究，发现烧伤后给予患者乳杆菌导致腹泻次数增加，血清C反应蛋白（CRP）和前白蛋白水平降低，且无显著临床受益，这可能与烧伤患者的肠黏膜完整性破坏、通透性增加有关。

JPEN J Parenter Enteral Nutr. 2016;40(4):140-141.

Clinical Value of Probiotic Treatment for Burn Patients.

Yuli Jiang; Kwaku Opoku; Eneko Larumbe-Zabala; Jenna E. Kesey; John A. Griswold; Sharmila Dissanaike.

Texas Tech University Health Sciences Center, Lubbock, TX, USA.

Purpose: Probiotics are often prescribed to help restore alterations in gut microflora from antibiotic usage in critical illnesses such as burns. While many studies exist on the efficacy of probiotics in gastrointestinal diseases such as Clostridium difficile infections and antibiotic-associated diarrhea, there are very few studies on the efficacy of probiotics in burn patients. One study analyzed the effects of probiotics on 10 pediatric burn cases. They noted a trend toward reduced incidences of fungal infection, improved GI outcomes, and reduced wound healing times, but unfortunately, they lacked sufficient sample size for a definitive conclusion. This study aims to assess the clinical usefulness of probiotics in burn patients.

Methods: A retrospective cohort study in adult burn patients given >1 million CFU/d of Lactobacillus acidophilus and Lactobacillus rhamnosus as routine supplementation. Subjects were divided into 3 groups: patients receiving ≥5 days of probiotics starting in the first week (n = 35), those receiving ≥ 5 days of probiotics starting later than the first week (n = 16), and a control group receiving <5 days of probiotics during their entire stay (n = 57). Data were collected on outcome variables: diarrhea, number of daily bowel movements, emesis, gastric residuals, C difficile infection, sepsis, serum CRP and prealbumin values, length of stay, and mortality. Confounding variables were laxative use and antimicrobial use. Multivariate analysis was performed with adjustment for TBSA and age using STATA.

Results: Demographics and injury characteristics were similar among groups, with mean body surface area of burn, 23.2% (0.2%-69.0%), and age, 46.7 years (18-82). There was no significant difference in clinical outcomes of C difficile infection, sepsis, emesis, gastric residuals, length of stay, or mortality. However, diarrhea occurred more frequently in subjects who received early probiotics (P = .001) and who had an average of 9.5 daily bowel movements vs 4.7 in controls (P = .001) in the first week, which increased to 17.4 vs 11.3 (P = .002) in the second week. Serum CRP was found to be higher for those who received probiotics, 12.45 vs 9.42 pg/mL (P = .015), while prealbumin was lower, 13.52 vs 17.59 pg/mL (P = .015).

Conclusions: Probiotic administration was associated with increased diarrhea and worse serum protein markers in adult burn patients, without perceptible clinical benefit. Alterations in gut permeability and integrity with severe burn may represent a potential cause for this finding. Probiotics should be used with caution in this population, and not in conjunction with other laxatives.

Financial support: None.