The Clinical Study Of Probiotics As An Add-on Therapy For Early Gastrointestinal Motility Disturbance Of Severe Acute Ischemic Attack Patients

Part? Determinant factors for early gastrointestinal motility disturbance of severe acute ischemic attackObjective To explore the risk factors for early gastrointestinal motility disturbance after severe acute ischemic attack.Methods Clinical data of 276 patients with severe acute ischemic attack using early eternal nutrition support were indentified retro-spectively.And the information of pulmonary infection and antibiotic use were also recorded.Several putative factors for early gastrointestinal motility disturbance were analyzed by univariate and multivariate binary logistic regression.Results Among the 276 patients,102 patients had early gastro-intestinal motility disturbance(GMD group),while the remaining 174 patients had no early gastrointestinal motility disturbance(non-GMD group).There are more patients with POCI and less with LACI or SAA in GMD group than those in non-GMD group according to TOAST and OCSP(P<0.05).The volume of 24 h eternal nutrition support in GMD group was less than that of non-GMD group(P<0.05).By univariate analysis,10 factors including baseline NIHSS score had significant differences(P<0.05).By multivariate analysis,baseline NIHSS score,APACHE II score,GCS score,fasting blood glucose,pulmonary infec-tion and the species of antibiotic use were the significant indepen-dent risk factors for early gastrointestinal motility disturbance in severe acute ischemic attack patients.It was showed in ROC study that AUC of baseline NIHSS(0.714,95%CI:00.652~ 0.775)was more than that of baseline APACHE II score(0.614,95%CI:0.549~ 0.679)?GCS score(0.391,95%CI:0.325 ~ 0.457)?fasting blood glucose(0.676,95%CI:0.612 ~ 0.741)and pulmonary infection(0.609,95%CI:0.549 ~ 0.668).The ratio of patients using tertiary-generation cephalosporin or quinolones in GMD group was more than that in non-GMD group(P < 0.05).Conclusions The degree of nervous functional defects and severity are the independent risk of early gastrointestinal motility disturbance after severe acute ischemic stroke.High level of baseline NIHSS increase the risk of early gastrointestinal motility disturbance and maybe lead to malnutrition.Acute pulmonary infection and using antibiotics(especially tertiary-generation cephalosporin and quinolones)can also increase the risk of early gastrointestinal motility disturbance.Part 2 The influence of early gastrointestinal motility disturbance on prognosis of severe acute ischemic stroke patientsObjective To observe the influence of early gastrointestinal motility disturbance in severe acute ischemic stroke patients.Methods 276 patients were divided into two groups : early gastro-intestinal motility disturbance group(GMD group)and no early gastrointestinal motility disturbance group(non-GMD group).Compared the nutrition score after 1 month,mRS score after 1 or 3 months and other gastrointestinal symptoms between two groups.The intraabdominal pressure,borborygmus,gastrin,72H-hsCRP and the ratio of SIRS were also compared.Among the patients with early gastro intestinal motility disturbance,the determined factors for prognosis were further analyzed by univariate and multivariate binary logistic regression.Results The albumin and pre-albumin after 1 month in GMD group were lower than that of non-GMD group(P<0.05).The mRS score,the ratio of poor prognosis after 1 or 3months,intra-abdominal pressure,gastrin and the incidence of gastrointestinal symptoms in GMD group were also higher than that of non-GMD group(P<0.05).GMD group was also inclined to higher 72H-hsCRP and the ratio of SIRS(P<0.05).In 102 patients of early gastrointestinal motility disturbance,baseline NIHSS score was the independent risk for the poor prognosis(P<0.05).There was negative correlation between mRS and the volume of 24 h eternal nutrition support.Conclusions Early gastrointestinal motility disturbance increase the risk of malnutrition,infection,SIRS and poor prognosis for the patients with acute severe ischemic stroke.Acute severe ischemic stroke patients with early gastrointestinal motility disturbance were inclined to have more gastrointestinal symptoms and higher intra-abdominal pressure,which increase the risk of other complications,and influence rehabi-litation.Severe nerve function defects increase not only the risk of early gastrointestinal motility disturbance,but also the risk of poor prognosis.Paying more attention to early gastrointestinal motility of acute severe ischemic stroke can decrease the complications and improve prognosis.Part 3 The effect of probiotics as an add-on therapy for early gastrointestinal motility disturbance of severe acute ischemic stroke patientsObjective To observe the effect of probiotics as an add-on therapy for early gastrointestinal motility disturbance of severe acute ischemic stoke.Methods Enroll 90 severe acute ischemic stroke patients with early gastrointestinal motility disturbance and 60 severe acute ischemic stroke patients without early gastrointestinal motility disturbance.All patients were divided into 4groups randomly and double-blindly:add-probiotics-GMD group(60patients),non-add-probiotics-GMD group(30patients),add-probiotics-non-GMD group(30 patients)and non-addprobiotics-non-GMD group(30 patients).Compared the nutrition score after 1 month,mRS score after 1 or 3 months,other gastrointestinal symptoms,intraabdominal pressure,borborygmus,gastrin,72H-hsCRP and the ratio of SIRS between four groups.Study also compared thethroatcoloniz-ation bacterias after adding probiotics.The prognosis and nutrition of patients using tertiary generation cephalosporin were studied especially.Results The albumin and pre-albumin after 1 month in add-probiotics-GMD group were higher than that of non-add-probiotics-GMD group(P<0.05).The mRS scores after 1 or 3months in add-probiotics-GMD group were also lower than those of non-addprobiotics-GMD group(P<0.05).Adding probiotics reduced the incidence of gastrointestinal symptoms and throat colonization bacteria(P<0.05).Adding probiotics was also useful for patients using tertiary generation cephalosporinConclusions Probiotics as an add-on therapy are useful to improve the nutrition,reduce the infection,benefit rehabilitation of nerve function and improve prognosis,especially in severe acute ischemic stroke with early gastrointestinal motility disturbance.