口服益生菌对肝部分切除术患者术后感染和肝功能恢复的影响

doi:10.3969/j.issn.1674-8115.2022.01.002

上海交通大学学报(医学版) ›› 2022, Vol. 42 ›› Issue (1): 9-15.doi: 10.3969/j.issn.1674-8115.2022.01.002

口服益生菌对肝部分切除术患者术后感染和肝功能恢复的影响

吴懿¹(), 方芳²(), 黄浩¹, 陈瑛¹

^1.上海交通大学附属第一人民医院肝胆胰外科，上海 200080
^2.上海交通大学附属第一人民医院护理部，上海 200080

收稿日期:2021-06-24 出版日期:2022-01-28 发布日期:2022-02-18
通讯作者: 方芳 E-mail:18121281590@189.cn;fang_fang0604@163.com
作者简介:吴懿（1983—），女，主管护师，硕士；电子信箱：18121281590@189.cn。
基金资助:
上海交通大学医学院科技基金(Jyh1903);上海市第一人民医院护理学院级课题(02.06.01.19.46);2020年上海市“医苑新星”人才计划

Influences of oral administration of probiotics on postoperative infection and liver function recovery in patients with partial hepatectomy

Yi WU¹(), Fang FANG²(), Hao HUANG¹, Ying CHEN¹

^1.Department of Hepatobiliary Pancreatic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
^2.Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China

Received:2021-06-24 Online:2022-01-28 Published:2022-02-18
Contact: Fang FANG E-mail:18121281590@189.cn;fang_fang0604@163.com
Supported by:
Science and Technology Fund of Shanghai Jiao Tong University School of Medicine(Jyh1903);Nursing Project of Shanghai General Hospital(02.06.01.19.46);Shanghai “Rising Stars of Medical Talent” Program(2020)

摘要/Abstract

摘要：

目的·探讨口服益生菌对肝部分切除术患者术后感染和肝功能恢复的影响。方法·入组上海交通大学附属第一人民医院165例行肝部分切除术的患者，应用随机数字表将患者分为传统机械性肠道准备组（MBP组，n=55）、无肠道准备组（NBP组，n=55）和益生菌肠道准备组（PBP组，n=55）。收集患者临床资料，包括基本信息，术后发热情况，排气排便时间，术后第1、3、5日感染指标和肝功能指标，并进行组间比较。结果·3组患者基本资料比较，差异均无统计学意义（均P>0.05）。术后第5日，PBP组患者白细胞计数显著低于MBP组（P=0.012）和NBP组（P=0.029）。术后第3日、第5日PBP组谷丙转氨酶水平较MBP组和NBP组显著降低（术后第3日：P=0.040，P=0.036。术后第5日：P=0.002，P=0.019）。结论·口服益生菌肠道准备有助于减轻肝部分切除术后感染，加快肝功能恢复。

关键词: 肝部分切除术, 肠道准备, 益生菌, 术后感染, 肝功能

Abstract:

Objective·To investigate the influences of oral administration of probiotics on postoperative infection and liver function recovery in patients with partial hepatectomy.

Methods·A total of 165 patients undergoing partial hepatectomy in Shanghai General Hospital, Shanghai Jiao Tong University, were involved in this prospective randomized control study. In accordance with the random number table, patients were divided into mechanical bowel preparation group (MBP group, n=55), non-bowel preparation group (NBP group, n=55) and probiotics bowel preparation group (PBP group, n=55). Patients' general information, postoperative fever, the first time of flatus and defecation, and infectious indexes and liver function indexes on the 1st,3rd and 5th day after operation were collected and compared among the groups.

Results·There was no significant difference in the basic data among the 3 groups (all P>0.05). On the 5th day after operation, the white blood count of the PBP group was significantly lower than that of the MBP group (P=0.012) and NBP group (P=0.029). The level of glutamic-pyruvic transaminase of the PBP group was significantly lower than that of the MBP group and NBP group on the 3rd day (P=0.040, P=0.036) and the 5th day (P=0.002, P=0.019) after operation.

Conclusion·Oral probiotics intestinal preparation is helpful to reduce infection after partial hepatectomy and accelerate the recovery of liver function.

Key words: partial hepatectomy, bowel preparation, probiotics, postoperative infection, liver function

中图分类号:

R473.6

吴懿, 方芳, 黄浩, 陈瑛. 口服益生菌对肝部分切除术患者术后感染和肝功能恢复的影响[J]. 上海交通大学学报(医学版), 2022, 42(1): 9-15.

Yi WU, Fang FANG, Hao HUANG, Ying CHEN. Influences of oral administration of probiotics on postoperative infection and liver function recovery in patients with partial hepatectomy[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2022, 42(1): 9-15.

图/表 4

参考文献 22

1	季昌永, 刘连新. 加速康复外科的规范与安全[J].中国普外基础与临床杂志, 2020, 27(1): 7-12.
2	李桂英. 术前机械性肠道准备对结肠癌患者肠道功能恢复和并发症的影响[J]. 护理实践与研究, 2019, 16(22): 100-101.
3	HOKUTO D, NOMI T, YAMATO I, et al. Impact of mechanical bowel preparation on postoperative outcomes after liver resection for patients with hepatocellular carcinoma: a single-center retrospective cohort study[J]. Dig Surg, 2016, 33(1): 51-57.
4	倪春燕, 杨芳, 蔡慧, 等. 肝切除患者术前肠道准备必要性的比较研究[J]. 护理学报, 2013, 20(20): 74-76.
5	中华医学会外科学分会, 中华医学会麻醉学分会. 加速康复外科中国专家共识及路径管理指南(2018版)[J]. 中国实用外科杂志,2018, 38(1): 1-20.
6	于鹏飞, 于亚男, 杨林, 等. 益生菌减少结直肠癌术后患者感染的Meta分析[J]. 中国微生态学杂志, 2017, 29(6): 639-642.
7	杨国威. 益生菌制剂在胰十二指肠切除术围手术期中的疗效分析[D].郑州: 郑州大学, 2018.
8	程玲, 高俊平. 益生菌在前列腺增生病人肠道准备中应用的效果评价[J]. 护理研究, 2019, 33(11): 1997-1999.
9	KIM W R, BIGGINS S W, KREMERS W K, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list[J]. N Engl J Med, 2008, 359(10): 1018-1026.
10	李强, 孙艺, 尚玉龙. 肠道准备与肠道微生态关系的研究进展[J]. 中国医药导报, 2019, 16(31): 42-45.
11	王燕, 贡丽雅, 王凤姣, 等. 益生菌联合肠内营养对结肠癌患者肠黏膜屏障功能及炎症反应的影响[J]. 中国医药导报, 2019, 16(14): 101-103, 108.
12	KOMATSU S, YOKOYAMA Y, NAGINO M. Gut microbiota and bacterial translocation in digestive surgery: the impact of probiotics[J]. Langenbecks Arch Surg, 2017, 402(3): 401-416.
13	CORNIDE-PETRONIO M E, ÁLVAREZ-MERCADO A I, JIMÉNEZ-CASTRO M B, et al. Current knowledge about the effect of nutritional status, supplemented nutrition diet, and gut microbiota on hepatic ischemia-reperfusion and regeneration in liver surgery[J]. Nutrients, 2020, 12(2): 284.
14	BAO Q, YU L, CHEN D, et al. Variation in the gut microbial community is associated with the progression of liver regeneration[J]. Hepatol Res, 2020, 50(1): 121-136.
15	周小琴, 赵文娟. 快速康复护理在肝外科的应用现状[J]. 护理实践与研究, 2016, 13(11): 22-24.
16	YASUEDA A, MIZUSHIMA T, NEZU R, et al. The effect of Clostridium butyricum MIYAIRI on the prevention of pouchitis and alteration of the microbiota profile in patients with ulcerative colitis[J]. Surg Today, 2016, 46(8): 939-949.
17	YOKOYAMA Y, ASAHARA T, NOMOTO K, et al. Effects of synbiotics to prevent postoperative infectious complications in highly invasive abdominal surgery[J]. Ann Nutr Metab, 2017, 71(Suppl 1): 23-30.
18	WANG H, HE C, LIU Y, et al. Soluble dietary fiber protects intestinal mucosal barrier by improving intestinal flora in a murine model of sepsis[J]. Biomed Pharmacother, 2020, 129: 110343.
19	ZHAI Q X, TIAN F W, ZHAO J X, et al. Oral administration of probiotics inhibits absorption of the heavy metal cadmium by protecting the intestinal barrier[J]. Appl Environ Microbiol, 2016, 82(14): 4429-4440.
20	LIU L, ZENG D, YANG M Y, et al. Probiotic Clostridium butyricum improves the growth performance, immune function, and gut microbiota of weaning rex rabbits[J]. Probiotics Antimicrob Proteins, 2019, 11(4): 1278-1292.
21	孙婷婷, 邓国炯, 郭春辉, 等. 双歧杆菌四联活菌片联合乳果糖对乙肝肝硬化患者肠道菌群和肠黏膜屏障功能及肝功能水平的影响[J]. 中国微生态学杂志, 2019, 31(8): 915-918, 922.
22	全敏, 邢卉春. 乳酸杆菌与肝病研究进展[J]. 中华实验和临床感染病杂志, 2019, 13(6): 467-471.

Item	MBP group （n=55）	NBP group （n=55）	PBP group （n=55）	P value
Gender/n				0.420
Male	43	37	41
Female	12	18	14
Age/n				0.887
≥60 years	22	24	20
<60 years	33	31	35
BMI/（kg·m^-2）	23.88±0.44	23.30±0.44	23.70±0.45	0.553
Liver cirrhosis/n				0.399
Yes	28	32	35
No	27	23	20
MELD score	47.28±1.64	53.97±4.20	52.25±4.18	0.415
Serum total bilirubin/（μmol·L^-1）	20.06±0.88	23.69±4.27	22.63±4.23	0.765
Serum albumin/（g·L^-1）	38.69±0.60	40.14±0.58	39.30±0.67	0.261
PT/s	11.77±0.14	11.46±0.10	11.63±0.13	0.180
INR	0.98±0.01	0.96±0.01	0.96±0.01	0.207
Serum creatinine/（μmol·L^-1）	67.21±1.77	72.33±3.54	68.64±3.30	0.459
White blood count/（×10⁹·L^-1）	7.26±0.56	7.18±0.57	7.27±0.57	0.992
Resected liver volume exceeded 30%/n				0.303
Yes	22	25	30
No	33	30	25
Operation time/min	187.60±8.60	181.40±9.43	197.50±9.86	0.457

Item	MBP group （n=55）	NBP group （n=55）	PBP group （n=55）	P value
Gender/n				0.420
Male	43	37	41
Female	12	18	14
Age/n				0.887
≥60 years	22	24	20
<60 years	33	31	35
BMI/（kg·m^-2）	23.88±0.44	23.30±0.44	23.70±0.45	0.553
Liver cirrhosis/n				0.399
Yes	28	32	35
No	27	23	20
MELD score	47.28±1.64	53.97±4.20	52.25±4.18	0.415
Serum total bilirubin/（μmol·L^-1）	20.06±0.88	23.69±4.27	22.63±4.23	0.765
Serum albumin/（g·L^-1）	38.69±0.60	40.14±0.58	39.30±0.67	0.261
PT/s	11.77±0.14	11.46±0.10	11.63±0.13	0.180
INR	0.98±0.01	0.96±0.01	0.96±0.01	0.207
Serum creatinine/（μmol·L^-1）	67.21±1.77	72.33±3.54	68.64±3.30	0.459
White blood count/（×10⁹·L^-1）	7.26±0.56	7.18±0.57	7.27±0.57	0.992
Resected liver volume exceeded 30%/n				0.303
Yes	22	25	30
No	33	30	25
Operation time/min	187.60±8.60	181.40±9.43	197.50±9.86	0.457

Item	MBP group （n=55）	NBP group （n=55）	PBP group （n=55）	P value
White blood count/（×10⁹·L^-1）
Postoperative day 1	14.55±0.63	13.82±0.64	14.25±0.64	0.592
Postoperative day 3	10.67±0.56^①	9.61±0.46	9.22±0.37	0.046
Postoperative day 5	8.13±0.38^②	8.09±0.38^③	7.11±0.29	0.031
Blood neutrophils count/（×10⁹·L^-1）
Postoperative day 1	12.69±0.61	12.10±0.61	12.53±0.62	0.671
Postoperative day 3	24.47±15.63	23.60±15.64	7.42±0.36	0.571
Postoperative day 5	5.76±0.32	5.42±0.29	5.33±0.26	0.442
Procalcitonin/（ng·mL^-1）
Postoperative day 1	1.99±0.86	1.90±0.86	2.59±1.17	0.523
Postoperative day 3	4.36±3.23	1.08±0.31	1.24±0.41	0.380
Postoperative day 5	0.48±0.01	1.33±0.85	1.43±0.86	0.576
Fungal D-glucan/（pg·mL^-1）
Postoperative day 1	220.40±48.73	227.80±48.64	267.50±64.25	0.562
Postoperative day 3	199.40±60.97	181.40±47.31	198.40±48.33	0.890
Postoperative day 5	124.10±35.40	101.70±25.88	132.40±33.91	0.545
Endotoxin limulus test/（EU·mL^-1）
Postoperative day 1	21.24±14.78	10.68±10.55	10.69±10.55	0.371
Postoperative day 3	1.49±1.32	1.46±1.32	0.19±0.06	0.627
Postoperative day 5	0.25±0.07	0.18±0.05	0.19±0.05	0.311
Interleukin-6/（pg·mL^-1）
Postoperative day 1	233.70±68.50	191.70±51.60	139.20±50.48	0.118
Postoperative day 3	98.97±17.68	96.41±16.44	103.40±20.89	0.877
Postoperative day 5	39.76±5.10	44.57±5.98	43.06±6.24	0.786

Item	MBP group （n=55）	NBP group （n=55）	PBP group （n=55）	P value
White blood count/（×10⁹·L^-1）
Postoperative day 1	14.55±0.63	13.82±0.64	14.25±0.64	0.592
Postoperative day 3	10.67±0.56^①	9.61±0.46	9.22±0.37	0.046
Postoperative day 5	8.13±0.38^②	8.09±0.38^③	7.11±0.29	0.031
Blood neutrophils count/（×10⁹·L^-1）
Postoperative day 1	12.69±0.61	12.10±0.61	12.53±0.62	0.671
Postoperative day 3	24.47±15.63	23.60±15.64	7.42±0.36	0.571
Postoperative day 5	5.76±0.32	5.42±0.29	5.33±0.26	0.442
Procalcitonin/（ng·mL^-1）
Postoperative day 1	1.99±0.86	1.90±0.86	2.59±1.17	0.523
Postoperative day 3	4.36±3.23	1.08±0.31	1.24±0.41	0.380
Postoperative day 5	0.48±0.01	1.33±0.85	1.43±0.86	0.576
Fungal D-glucan/（pg·mL^-1）
Postoperative day 1	220.40±48.73	227.80±48.64	267.50±64.25	0.562
Postoperative day 3	199.40±60.97	181.40±47.31	198.40±48.33	0.890
Postoperative day 5	124.10±35.40	101.70±25.88	132.40±33.91	0.545
Endotoxin limulus test/（EU·mL^-1）
Postoperative day 1	21.24±14.78	10.68±10.55	10.69±10.55	0.371
Postoperative day 3	1.49±1.32	1.46±1.32	0.19±0.06	0.627
Postoperative day 5	0.25±0.07	0.18±0.05	0.19±0.05	0.311
Interleukin-6/（pg·mL^-1）
Postoperative day 1	233.70±68.50	191.70±51.60	139.20±50.48	0.118
Postoperative day 3	98.97±17.68	96.41±16.44	103.40±20.89	0.877
Postoperative day 5	39.76±5.10	44.57±5.98	43.06±6.24	0.786

Item	MBP group （n=55）	NBP group （n=55）	PBP group （n=55）	P value
GPT/（U·L^-1）
Postoperative day 1	310.70±28.12	274.70±27.08	296.60±28.80	0.509
Postoperative day 3	215.30±21.56^①	216.70±22.19^②	156.60±18.66	0.043
Postoperative day 5	109.10±8.74^③	119.50±13.06^④	83.36±7.47	0.017
GOT/（U·L^-1）
Postoperative day 1	313.70±25.47	291.00±25.33	310.90±27.29	0.700
Postoperative day 3	105.20±10.11	119.70±14.33	97.34±8.59	0.294
Postoperative day 5	48.13±3.20	51.30±5.93	41.72±3.18	0.229
Serum total bilirubin/（μmol·L^-1）
Postoperative day 1	23.09±1.70	26.51±3.12	24.36±2.91	0.652
Postoperative day 3	23.21±1.42	25.45±2.38	24.89±2.38	0.733
Postoperative day 5	21.19±1.30	23.24±1.92	21.56±1.87	0.639
Serum direct bilirubin/（μmol·L^-1）
Postoperative day 1	8.49±1.01	9.99±1.86	9.49±1.73	0.778
Postoperative day 3	8.84±0.68	9.66±1.21	9.42±1.20	0.848
Postoperative day 5	7.18±0.52	7.73±0.84	7.76±0.84	0.808
PT/s
Postoperative day 1	13.02±0.18	12.77±0.18	12.77±0.20	0.379
Postoperative day 3	13.06±0.19^⑤	12.87±0.18^⑥	12.39±0.18	0.011
Postoperative day 5	12.81±0.17^⑦	12.37±0.27	11.75±0.33	0.007
INR
Postoperative day 1	1.09±0.02	1.06±0.02	1.37±0.29	0.382
Postoperative day 3	1.09±0.02	1.08±0.02	1.05±0.01	0.082
Postoperative day 5	1.08±0.01	1.06±0.01	1.04±0.01	0.115

口服益生菌对肝部分切除术患者术后感染和肝功能恢复的影响

Influences of oral administration of probiotics on postoperative infection and liver function recovery in patients with partial hepatectomy

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 4

参考文献 22

相关文章 9

编辑推荐

Metrics

Item	MBP group （n=55）	NBP group （n=55）	PBP group （n=55）	P value
Preoperative thirst/n				0.000
Yes	37	16	20
No	18	39	35
Exhaust time/d	2.38±0.14	2.53±0.14	2.36±0.16	0.522
Defecate time/d	3.35±0.20	3.51±0.21	3.75±0.22	0.334
Postoperative fever（above 38 ℃）/n				0.145
Yes	15	20	16
No	40	35	39

[1]	谷婷婷，赖东梅. 肠道菌群与妇产科疾病的相关性研究进展[J]. 上海交通大学学报（医学版）, 2018, 38(8): 967-.
[2]	许飞，汤玲琳，袁红，宋少莉,黄钢. 分化型甲状腺癌患者碘治疗前肝功能、血脂及血常规水平变化[J]. 上海交通大学学报（医学版）, 2018, 38(6): 632-.
[3]	李雪琳，顾燕云，张翼飞 . 益生菌改善 2 型糖尿病的相关机制[J]. 上海交通大学学报（医学版）, 2017, 37(9): 1309-.
[4]	秦黄雯，王岚，邹静，朱金水 . 四磨汤联合甘露醇对磁控胶囊内镜肠道准备效果的作用#br#[J]. 上海交通大学学报（医学版）, 2017, 37(8): 1116-.
[5]	车荣华，刘敏，杨杰莲，瞿俊杰，应豪 . 乙型肝炎病毒阳性与妊娠期糖尿病的相关性研究[J]. 上海交通大学学报（医学版）, 2016, 36(11): 1636-.
[6]	钱道海, 沈柏用, 彭承宏, 等. 尸体供肝移植术后被动肝动脉缓冲效应的相关研究[J]. , 2012, 32(6): 771-.
[7]	吴书其, 李瑾, 叶智轶, 等. 分化型甲状腺癌¹³¹I治疗对患者肝肾功能的影响[J]. , 2010, 30(3): 271-.
[8]	王坚镪, 丁在咸, 张旻, 等. 益生菌对炎症性肠病小鼠肠道菌群紊乱及细菌移位的影响[J]. , 2010, 30(2): 186-.
[9]	唐文静, 黄娟, 钟燕, 等. 益生菌干预对卵清蛋白过敏幼鼠模型的免疫调节作用[J]. , 2010, 30(1): 4-.