Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Crit Care Med. 2012 Dec;40(12):3290-302. doi: 10.1097/CCM.0b013e318260cc33.
Critical illness results in changes to the microbiology of the gastrointestinal tract, leading to a loss of commensal flora and an overgrowth of potentially pathogenic bacteria. Administering certain strains of live bacteria (probiotics) to critically ill patients may restore balance to the microbiota and have positive effects on immune function and gastrointestinal structure and function. The purpose of this systematic review was to evaluate the effect of probiotics in critically ill patients on clinical outcomes.
Systematic review.
None.
We searched computerized databases, reference lists of pertinent articles, and personal files from 1980 to 2011. We included randomized controlled trials enrolling critically ill adults, which evaluated probiotics compared to a placebo and reported clinically important outcomes (infections, mortality, and length of stay). A total of 23 randomized controlled trials met inclusion criteria. Probiotics were associated with reduced infectious complications as documented in 11 trials (risk ratio 0.82; 95% confidence interval 0.69-0.99; p = .03; test for heterogeneity p = .05; I 44%). When data from the seven trials reporting ventilator-associated pneumonia were pooled, ventilator-associated pneumonia rates were also significantly reduced with probiotics (risk ratio 0.75; 95% confidence interval 0.59-0.97; p = .03; test for heterogeneity p = .16; I 35%). Probiotics were associated with a trend toward reduced intensive care unit mortality (risk ratio 0.80; 95% confidence interval 0.59-1.09; p = .16; test for heterogeneity p = .89; I 0%) but did not influence hospital mortality. Probiotics had no effect on intensive care unit or hospital length of stay. Compared to trials of higher methodological quality, greater treatment effects were observed in trials of a lower methodological quality.
Probiotics appear to reduce infectious complications including ventilator-associated pneumonia and may influence intensive care unit mortality. However, clinical and statistical heterogeneity and imprecise estimates preclude strong clinical recommendations. Further research on probiotics in the critically ill is warranted.
危重病可导致胃肠道微生物群发生变化，使共生菌群丧失，潜在致病菌过度生长。向危重病患者给予某些特定菌株的活菌（益生菌）可能会使微生物群恢复平衡，并对免疫功能和胃肠道结构与功能产生积极影响。本系统评价的目的是评估益生菌对危重病患者的临床结局的影响。
系统评价。
无。
我们检索了 1980 年至 2011 年的计算机数据库、相关文章的参考文献列表和个人档案。我们纳入了纳入成年危重病患者的随机对照试验，这些试验评估了益生菌与安慰剂相比，并报告了临床重要结局（感染、死亡率和住院时间）。共有 23 项随机对照试验符合纳入标准。11 项试验证实益生菌可降低感染性并发症（风险比 0.82；95%置信区间 0.69-0.99；p =.03；异质性检验 p =.05；I 2 =44%）。当汇总了报告呼吸机相关性肺炎的 7 项试验的数据时，益生菌也可显著降低呼吸机相关性肺炎的发生率（风险比 0.75；95%置信区间 0.59-0.97；p =.03；异质性检验 p =.16；I 2 =35%）。益生菌与 ICU 死亡率降低呈趋势相关（风险比 0.80；95%置信区间 0.59-1.09；p =.16；异质性检验 p =.89；I 0%），但不影响住院死亡率。益生菌对 ICU 或住院时间无影响。与方法学质量较高的试验相比，方法学质量较低的试验观察到的治疗效果更大。
益生菌似乎可降低感染性并发症（包括呼吸机相关性肺炎），并可能影响 ICU 死亡率。然而，临床和统计学的异质性以及不精确的估计值妨碍了强烈的临床推荐。有必要对益生菌在危重病患者中的应用进行进一步的研究。
