School of Rehabilitation Medicine.
First School of Clinical Medicine.
Medicine (Baltimore). 2021 Apr 30;100(17):e25657. doi: 10.1097/MD.0000000000025657.
Malnutrition is commonly observed after stroke and is closely associated with poor clinical outcomes. So, early nutrition support is particularly crucial for severe stroke patients. However, a significant number of critically ill patients are intolerant to enteral nutrition (EN). Probiotics have been widely used in malnutrition by various diseases and have a low incidence of enteral intolerance. So, we aim to elucidate the efficacy of probiotics in EN in improving the nutritional status and clinical prognosis of severe stroke patients with nasal feeding.
Embase, PubMed, Sinomed, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang database, and Vip Journal Integration Platform were searched from inception to March 31, 2021. Randomized controlled trials that applied probiotics in patients with severe stroke were included. The data were extracted and the risk of bias was assessed independently by 2 evaluators.
Twenty-four studies comprising 2003 participants of randomized controlled trials were included. The result of pooled analyses showed that probiotics in EN were associated with better outcomes than EN alone on Glasgow Coma Scale score (mean difference [MD] = 1.03, 95% confidence intervals [CI]: 0.78-1.27; P < .00001), infection events (odds ratio [OR] = 0.25, 95% CI: 0.15-0.43; P < .00001), rate of intestinal flora dysbiosis (OR = 0.24, 95% CI: 0.12-0.48; P < .0001), gastrointestinal complications (OR = 0.25, 95% CI: 0.16-0.37, P < .00001), time to reach target nutrition (MD = -1.80, 95% CI: -2.42 to 1.18, P < .00001), prealbumin content (MD = 25.83, 95% CI: 13.68-37.99, P < .0001).
Our results demonstrated that probiotics supplementation might be an effective intervention for improving the clinical prognosis in severe stroke patients with nasal feeding, but no significant effect on increasing muscle circumference.
脑卒中后常发生营养不良，与不良临床结局密切相关。因此，早期营养支持对重症脑卒中患者尤为重要。然而，相当数量的危重症患者不能耐受肠内营养（EN）。益生菌已广泛应用于各种疾病导致的营养不良，且肠内不耐受发生率较低。因此，我们旨在阐明益生菌在 EN 中改善经鼻饲重症脑卒中患者营养状况和临床预后的疗效。
检索 Embase、PubMed、Sinomed、Web of Science、Cochrane 图书馆、中国知网、万方数据库和维普期刊整合服务平台，检索时间均从建库至 2021 年 3 月 31 日。纳入应用益生菌治疗重症脑卒中患者的随机对照试验。由 2 名评价者独立提取数据并评价偏倚风险。
共纳入 24 项研究，包括 2003 例随机对照试验患者。汇总分析结果显示，与单独 EN 相比，益生菌 EN 可改善患者的格拉斯哥昏迷量表评分[均数差（MD）=1.03，95%置信区间（CI）：0.781.27；P<0.00001]、感染事件[比值比（OR）=0.25，95%CI：0.150.43；P<0.00001]、肠道菌群失调发生率[OR=0.24，95%CI：0.120.48；P<0.0001]、胃肠道并发症[OR=0.25，95%CI：0.160.37，P<0.00001]、达到目标营养时间[MD=-1.80，95%CI：-2.42-1.18，P<0.00001]和前白蛋白含量[MD=25.83，95%CI：13.6837.99，P<0.0001]。
本研究结果表明，益生菌补充可能是改善经鼻饲重症脑卒中患者临床预后的有效干预措施，但对增加肌肉周长无显著影响。
