| Objective:In recent years,some animal experiments and clinical studies have shown that probiotics have made some progress in the prevention and control of infection,but they have not been widely used in clinical practice.The application of probiotics in the prevention and treatment of abdominal infection after liver transplantation is rare,and its clinical effect is not clear.Therefore,our group chose the perioperative intestinal microecological intervention program to observe the effect of this program on the improvement of intestinal flora,the reduction of bacterial translocation and the prevention and treatment of abdominal infection after liver transplantation.Methods:(1)50 patients undergoing liver transplantation from June 2017 to January 2019 in our hospital were randomly divided into observation group and control group,25 cases in each group.The control group was given routine preoperative preparation plan: 1 day before operation,total fasting;2 hours before operation,intestinal tract was cleaned.The observation group received perioperative intestinal microecological intervention on the basis of routine program: oral Bifidobacterium triple viable capsules(mainly Lactobacillus and bifidobacterium)one day before operation,and oral Bifidobacterium triple viable capsules 1-2 days after operation(that is,after open diet)until 15 days after operation.(2)On the first day before liver transplantation,the seventh day and the fifteenth day after liver transplantation,two fresh stool specimens were collected from the observation group and the control group respectively.One was used to count and identify viable colonies of aerobic bacteria,facultative anaerobic bacteria and fungi,and the other was used to detect ten pairs of intestinal microflora by fluorescence quantitative polymerase chain reaction(qPCR)to understand the changes of the main intestinal flora in the two groups.(3)On the first day before liver transplantation,the seventh day after operation and the fifteenth day after operation,venous blood was collected from the observation group and the control group,liver function and PCT level were measured,and the differences between the two groups were analyzed.(4)Isolation and identification of pathogenic bacteria from fresh abdominal drainage fluid of patients were carried out once a day within 15 days after liver transplantation,and homology detection and analysis were carried out with the same strains isolated from the intestinal tract of the host to determine bacterial translocation(BT)or abdominal infection,and to understand the bacterial translocation in the observation group and the control group.Results:(1)The results of fecal culture and qPCR in observation group and control group showed that the intestinal probiotics represented by Bifidobacterium and Lactobacillus showed a significant downward trend after liver transplantation,while the Enterococcus content showed a certain upward trend.The contents of Bifidobacterium and Lactobacillus in the observation group were significantly higher than those in the control group on the 7th and 15 th day after operation(P < 0.05),while the counts of Enterobacter,Enterococcus and Candida were significantly lower than those in the control group on the 15 th day after operation(P < 0.01).In terms of B/E value,the observation group was significantly improved after operation,and was significantly higher than the control group on the 7th and 15 th day after operation(P < 0.01).(2)The results of liver function and PCT test after liver transplantation showed that the levels of ALT,AST,TB and DB in the observation group were lower than those in the control group on the 7th day after operation(P < 0.01),while the levels of PCT in the observation group were lower than those in the control group(P < 0.05),and the levels of ALT and AST in the observation group were significantly lower than those in the control group on the 15 th day after operation(P < 0.05).The difference was statistically significant(P < 0.05).There was no significant difference in bilirubin levels between the two groups.At the same time,the results of CT in both groups were less than 0.5ug/L,and there was no significant difference(P > 0.05).(3)Homology analysis of 13 pairs of bacteria isolated from abdominal cavity and intestinal tract after liver transplantation showed that 10 pairs of genotypes were homologous.The incidence of BT in the control group was 32%.There were 5 strains of Escherichia coli,2 strains of Enterobacter aerogenes and 1 strain of Enterococcus faecium in the control group.Six of them considered that BT caused abdominal infection.The incidence of BT in the observation group was 8%.All of them were Escherichia coli,and one of them considered that BT caused abdominal infection.The incidence of BT and abdominal infection in the observation group was significantly lower than that in the control group(P < 0.05).Conclusion:(1)Before liver transplantation,the intestinal flora imbalance in the observation group and the control group was observed,and the B/E value of colonization resistance decreased.The content of Bifidobacterium and Lactobacillus in the control group decreased significantly after operation compared with that before liver transplantation;at the same time point after operation,the content of Bifidobacterium and Lactobacillus in the observation group with microecological intervention was significantly higher than that in the control group,while the content of Enterococcus and Enterobacter in the observation group was significantly lower than that in the control group;perioperative dried probiotic viant preparation Beifeikang Pre-treatment can improve the intestinal flora imbalance after operation.(2)Intestinal microecological intervention after liver transplantation can improve the recovery of liver function,reduce the level of PCT and reduce the incidence of sepsis.(3)Intestinal BT occurred in both groups after liver transplantation,and there was a certain correlation between BT and abdominal infection after liver transplantation.Perioperative supplementation of probiotic bificon can reduce the incidence of BT and abdominal infection after liver transplantation. |
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