预测严重急性胰腺炎的益生菌预防:一个随机,双盲,安慰剂对照试验
Marc Gh Besselink1, Hjalmar C van Santvoort1, Erik Buskens2
1Department of Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
Lancet (London, England)
|February 19, 2008
概括
益生菌预防不能预防严重急性胰腺炎的传染性并发症和增加死亡风险. 由于潜在的危害,包括肠道缺血症,这些患者应避免使用益生菌.
科学领域:
- 胃肠病学 胃肠病学
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
背景情况:
- 感染性并发症和死亡率是急性胰腺炎的重大问题.
- 肠道益生菌可以预防感染,但证据有限.
- 这项研究评估了预测严重急性胰腺炎的益生菌预防.
研究的目的:
- 评估益生菌预防在预测严重急性胰腺炎的患者减少感染并发症的有效性.
- 确定益生菌预防对该患者群的死亡率的影响.
主要方法:
- 一个多中心,随机,双盲,安慰剂对照试验,涉及298名预测患有严重急性胰腺炎的患者.
- 患者接受了多种类型的益生菌制剂或安慰剂,每天输入两次,持续28天.
- 主要终点是感染性并发症的复合,随访90天.
主要成果:
- 感染性并发症发生在益生菌组的30%,而安慰剂组的28% (RR 1.06,95% CI 0.75-1.51).
- 在益生菌组 (16%) 的死亡率明显高于安慰剂组 (6%) (RR 2.53,95% CI 1.22-5.25).
- 益生菌组的9名患者患有肠道缺血症,有8例致命结局,而安慰剂组没有 (p=0.004).
结论:
- 益生菌预防没有减少预测严重急性胰腺炎的感染并发症.
- 益生菌使用与死亡率增加和肠道缺血的风险增加有关.
- 益生菌预防不应给预测患有严重急性胰腺炎的患者.
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