Morrow Lee E
Creighton University Medical Center, Division of Pulmonary, Critical Care and Sleep Medicine, Omaha, Nebraska, USA.
Curr Opin Crit Care. 2009 Apr;15(2):144-8. doi: 10.1097/MCC.0b013e3283252d2d.
To examine current knowledge regarding the utility of probiotics in a variety of medical conditions afflicting critically ill patients in the intensive care unit (ICU).
Recent experimental and clinical studies have furthered our understanding regarding the use of probiotic therapy across various clinical conditions. These disorders include antibiotic-associated diarrhea, Clostridium difficile-associated diarrhea, acute pancreatitis, ventilator-associated pneumonia, and sepsis among others. Although each of these conditions is germane to ICU patients, few studies have specifically studied this vulnerable population. The current data supporting the use of probiotics in the treatment of these different clinical conditions consist mostly of the results of small, single-center trials with varying quality of research design. Although recent studies have also generally demonstrated favorable results, one well designed study in severe pancreatitis found increased mortality with probiotic therapy. These results emphasize the need for improved data regarding mechanisms of action as well as rigorous attention to safety monitoring during the execution of probiotic clinical trials.
Data supporting the use of probiotics in different clinical conditions are variable in scope and quality. Large, well designed, randomized, multicenter trials are needed to better define the role and safety of probiotics in critically ill patients.
探讨目前关于益生菌在重症监护病房（ICU）中患有各种疾病的重症患者治疗中应用的相关知识。
近期的实验和临床研究进一步加深了我们对益生菌疗法在各种临床病症中应用的理解。这些病症包括抗生素相关性腹泻、艰难梭菌相关性腹泻、急性胰腺炎、呼吸机相关性肺炎以及脓毒症等。尽管这些病症都与ICU患者密切相关，但很少有研究专门针对这一脆弱人群进行研究。目前支持使用益生菌治疗这些不同临床病症的数据大多来自质量参差不齐的小型单中心试验结果。虽然近期研究总体上也显示出了良好效果，但一项针对重症胰腺炎的精心设计的研究发现，益生菌治疗会增加死亡率。这些结果强调了在益生菌临床试验实施过程中，需要有关于作用机制的更完善数据以及对安全监测的严格关注。
支持在不同临床病症中使用益生菌的数据在范围和质量上存在差异。需要进行大规模、精心设计、随机、多中心试验，以更好地明确益生菌在重症患者中的作用和安全性。
