The influence of symbiotics in multi-organ failure: Randomised trial
The influence of symbiotics in multi-organ failure: Randomised trial
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DOI：
10.1016/j.medcli.2013.09.046
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发表时间：
2014-08-19
期刊：
影响因子：
3.9
通讯作者：
Angeles Arrese-Cosculluela, M.
中科院分区：
文献类型：
--
作者：
de Toro Martin-Consuegra, Ismael Lopez;Sanchez-Casado, Marcelino;Angeles Arrese-Cosculluela, M.
背景与目的：评估多器官功能衰竭（MOF）患者给予共生制剂是否会减少功能衰竭的演变、产生的炎症反应、定植模式和重症监护病房（ICU）传染病。患者和方法：随机对照试验。所有MOF患者均被纳入。中性粒细胞减少症和急性胰腺炎患者除外。前7天通过肠内喂养一种共生菌（simbiodrinko (R)）。感兴趣的变量是：顺序器官衰竭评估（SOFA）评分演变，乳酸、纤维蛋白原和d -二聚体的全身浓度；皮肤和粘膜定植和传染病登记。结果：纳入89例患者；共生组（SG） 46只，对照组（CG） 43只。男性占68.5%，中位年龄69岁。两组患者的基本特征（病史、年龄、入院原因、严重程度评分）、ICU住院时间和死亡率均无显著差异。SG组与CG组比较，第2天乳酸水平较低，第5、7天纤维蛋白原水平较高。第7天d -二聚体水平较低。进行了895次培养以进行定植评估，分离出528种微生物。微生物耐药性无差异；第3天后，粘膜上的Candid在SG中的定植量增加；这种情况在停止共生给药后得到解决。重症监护室22例，SG 14例（42.4%），CG 19例（57.6%）。虽然在微生物学模式上没有发现差异，但念珠菌属的优势优于其他微生物（4例对0例）。结论：共生制剂simbibidrink (R)对MOF患者早期乳酸水平和晚期纤维蛋白原/ d -二聚体水平以及念珠菌在粘膜的定殖均有改善作用。ICU的发展没有差异。(C) 2013爱思唯尔西班牙公司。版权所有。
Background and objective: To assess whether the administration of symbiotic preparations in patients with multi-organ failure (MOF) diminishes the evolution of the failure, the inflammatory response generated, the colonization pattern and the Intensive Care Unit (ICU) infectious illness.Patients and method: Randomized and controlled trial. All patients with MOF were included. Neutropenia and acute pancreatitis patients were excluded. A symbiotic (Simbiotic Drinko (R)) was administered via enteral feeding during the first 7 days. Variables of interest were: Sequential Organ Failure Assessment (SOFA) score evolution, systemic concentrations of lactate, fibrinogen and D-dimer; skin and mucosa colonization and infectious disease register.Results: Eighty-nine patients were included; 46 in the symbiotic group (SG) and 43 in the control group (CG). There were 68.5% males, with a median age of 69 years. There were no significant differences in the patients' fundamental characteristics (medical history, age, reason for admission, severity scores), nor in the length of ICU stay or in mortality. Comparing the SG with the CG, there were lower lactate levels on the second day, more fibrinogen levels on the days 5 and 7. and lower D-dimer levels on the day 7. Eight hundred and ninety-five cultures were performed for colonization assessment, with isolation of 528 microorganisms. No differences in microbiological resistance were found; there were more colonization in the SG by Candid in mucous membranes after the third day; this situation resolved after stopping symbiotic administration. Twenty-two patients suffered an infectious disease in ICU, 14 in SG (42.4%) and 19 in CG (57.6%). Although no differences were found in the microbiological pattern, there was a predominance of Candida spp. over other microorganisms (4 vs. 0 cases).Conclusions: The symbiotic preparation Simbiotic Drink (R), administered in MOF, results in differences to improve the early lactate levels and late fibrinogen/D-dimer levels as well as mucosa colonization by Candida. There were no differences in the ICU evolution. (C) 2013 Elsevier Espana. S.L. All rights reserved.