Ho Kwok M, Kalgudi Shankar, Corbett Jade-Marie, Litton Edward
Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Australia.
School of Veterinary and Life Sciences, Murdoch University, Perth, Australia.
Anaesth Intensive Care. 2020 May;48(3):179-195. doi: 10.1177/0310057X20903732. Epub 2020 Mar 4.
Microbiota-defined as a collection of microbial organisms colonising different parts of the human body-is now recognised as a pivotal element of human health, and explains a large part of the variance in the phenotypic expression of many diseases. A reduction in microbiota diversity, and replacement of normal microbes with non-commensal, pathogenic or more virulent microbes in the gastrointestinal tract-also known as gut dysbiosis-is now considered to play a causal role in the pathogenesis of many acute and chronic diseases. Results from animal and human studies suggest that dysbiosis is linked to cardiovascular and metabolic disease through changes to microbiota-derived metabolites, including trimethylamine-N-oxide and short-chain fatty acids. Dysbiosis can occur within hours of surgery or the onset of critical illness, even without the administration of antibiotics. These pathological changes in microbiota may contribute to important clinical outcomes, including surgical infection, bowel anastomotic leaks, acute kidney injury, respiratory failure and brain injury. As a strategy to reduce dysbiosis, the use of probiotics (live bacterial cultures that confer health benefits) or synbiotics (probiotic in combination with food that encourages the growth of gut commensal bacteria) in surgical and critically ill patients has been increasingly reported to confer important clinical benefits, including a reduction in ventilator-associated pneumonia, bacteraemia and length of hospital stay, in small randomised controlled trials. However, the best strategy to modulate dysbiosis or counteract its potential harms remains uncertain and requires investigation by a well-designed, adequately powered, randomised controlled trial.
微生物群被定义为定殖于人体不同部位的微生物有机体的集合，如今被认为是人类健康的关键要素，并且可以解释许多疾病表型表达差异的很大一部分原因。微生物群多样性的降低，以及胃肠道中正常微生物被非共生、致病或毒性更强的微生物所取代（也称为肠道菌群失调），现在被认为在许多急性和慢性疾病的发病机制中起因果作用。动物和人体研究结果表明，菌群失调通过微生物群衍生代谢物的变化与心血管和代谢疾病相关，这些代谢物包括氧化三甲胺和短链脂肪酸。即使不使用抗生素，菌群失调也可能在手术数小时内或危重病发作时发生。微生物群的这些病理变化可能导致重要的临床后果，包括手术感染、肠吻合口漏、急性肾损伤、呼吸衰竭和脑损伤。作为减少菌群失调的一种策略，在小型随机对照试验中，越来越多的报告称，在手术患者和危重病患者中使用益生菌（具有健康益处的活细菌培养物）或合生元（益生菌与促进肠道共生细菌生长的食物组合）可带来重要的临床益处，包括降低呼吸机相关性肺炎、菌血症的发生率以及缩短住院时间。然而，调节菌群失调或抵消其潜在危害的最佳策略仍不确定，需要通过设计良好、样本量充足的随机对照试验进行研究。
