益生菌联合水溶性膳食纤维对老年抗生素相关性腹泻的防治效果

摘要

目的 研究益生菌联合水溶性膳食纤维(SDF)对防治老年抗生素相关性腹泻(ADD)的有效性和安全性.方法 选取2014年8月—2016年8月间使用抗生素的老年住院患者(≥65岁)88例为研究对象,随机分为对照组(26例)、益生菌组(30例)和联合组(32例).对照组给予麦芽糊精做安慰剂,益生菌组给予三联活菌片干预,联合组给予三联活菌片和SDF干预,观察时间为14 d.监测3组患者ADD的发生率、复发率、粪便培养结果以及不良反应的发生率.结果 联合组和益生菌组患者ADD的发生率均低于对照组(6.25% vs.26.92%,6.67% vs.26.92%,P<0.05);联合组与益生菌组比较,腹泻病程缩短[(3.53±0.62)d vs.(4.39±1.01)d,P<0.05];与对照组[(3.55±0.65)d]比较,腹泻病程无明显差异.益生菌组干预7 d后,肠球菌计数即有明显下降,乳酸杆菌和双歧杆菌干预14 d后总体无明显变化.联合组干预7 d后,肠球菌计数下降,至14 d时有所上升,双歧杆菌和乳酸杆菌计数随时间逐渐增加(P<0.05).联合组、益生菌组和对照组的总不良反应发生率分别为6.25%、10.00%和23.07%,差异无统计学意义.结论 益生菌联合SDF在预防老年抗生素相关性腹泻发生和缩短腹泻病程方面均有良好的临床效果,在调节肠道菌群方面有积极作用,且耐受性好.%Objective To investigate the clinical usefulness and safety of soluble dietary fiber (SDF) combined with probiotics in treating elderly patients with antibiotic associated diarrhea(AAD).Methods A total of 88 hospitalized elderly patients (≥65 years old) treated with antibiotics during August 2014 to August 2016 were included in this study. Patients were divided into control group(26 cases),probiotics group(30 cases)and combined group(32 cases).The control group was given maltodextrin as placebo intervention, the probiotics group was given the same dose of probiotics only, and the combined group was given SDF and probiotics treatment. The treatment was observed for 14 d. The incidence and the recurrence rate of ADD, the results of fecal culture and the incidence of adverse reactions were monitored in the three groups. Results The incidence of ADD was obviously lower in the combined group and the probiotics group than that of control group(6.25% vs.26.92%,6.67% vs.26.92%,P<0.05).The disease duration of diarrhea was shorter in the combined group than that of probiotic group[(3.53 ± 0.62)d vs.(4.39 ± 1.01)d,P<0.05],but no difference was found when compared with that of control group [(3.55 ± 0.65) d]. After 7-day intervention, Enterococcus counts was significantly deceased in probiotic group(P<0.05).There were no significant changes in Lactobacillus and Bifidobacterium counts in probiotic group after 14-day intervention. In the combined group, after 7-day intervention, Enterococcus counts decreased (P<0.05), and then started increasing until the 14-day(P<0.05).Lactobacillus and Bifidobacterium counts increased with the time passed (P<0.05).The incidence rates of total adverse reactions were 6.25%,10.00% and 23.07% for combined group,probiotics group and control group,and with no significant differences between them.Conclusion The probiotics combined with SDF has a good clinical effect on preventing the occurrence of antibiotic associated diarrhea and shortening the course of diarrhea in the elderly.It has high safety and it can regulate the intestinal flore with high safety.