基于脑–肠轴探讨早期肠道补充益生菌对重型创伤性颅脑损伤患者预后的影响

The Impact of Early Gut Probiotic Supplementation on the Prognosis of Patients with Severe Traumatic Brain Injury: Based on the Gut-Brain Axis

摘要: 目的：探讨早期肠道补充益生菌对重型创伤性颅脑损伤(Traumatic brain injury, TBI)患者肠道功能恢复及追踪对TBI认知和行为结果的影响。方法：纳入2024年东台市人民医院重症医学科收治的重型TBI患者，根据治疗方案的不同分为两组，对照组采用颅脑损伤标准化治疗方案，研究组在对照组基础上于入科24小时内经鼻饲管予双歧杆菌三联活菌肠溶胶囊治疗。比较两组肠内营养耐受性、短期肠道功能及营养代谢、神经功能预后等情况，随访6个月时的认知与行为结果作为研究终点。结果：肠道功能与营养代谢方面，研究组患者的首次排便时间(2.61 ± 1.45天 vs. 3.36 ± 1.48天)、喂养状况稳定时间(5.47 ± 2.62天 vs. 7.24 ± 2.93天)均显著短于对照组(P < 0.05)，腹胀发生率亦显著低于对照组(30.00% vs. 55.88%, P < 0.05)，且血清白蛋白水平更高(30.77 ± 5.26 g/L vs. 27.31 ± 4.22 g/L, P < 0.01)；两组间腹泻发生率及便秘发生率差异无统计学意义。在神经功能预后方面，两组患者出院后3个月与6个月的GOS评分比较，以及出院6个月内的病死率(6.67% vs. 14.70%)差异均无统计学意义(P > 0.05)。结论：早期益生菌干预能有效促进重型颅脑损伤患者的肠道功能恢复与营养改善，但在本研究的随访期内未观察到其对神经功能预后有显著提升作用。

Abstract: Objective: This study aimed to investigate the effects of early probiotic supplementation on intestinal function recovery and to evaluate its subsequent impact on cognitive and behavioral outcomes in patients with severe traumatic brain injury (TBI). Methods: Patients with severe TBI admitted to the ICU of Dongtai People’s Hospital in 2024 were enrolled and divided into two groups based on their treatment regimen. The control group received standard management for TBI. The study group received the standard treatment plus supplemental Bifidobacterium triple viable capsules administered via a nasogastric tube within 24 hours of ICU admission. Parameters including enteral nutrition tolerance, short-term intestinal function, nutritional metabolism, and neurological prognosis were compared between the two groups. Cognitive and behavioral outcomes at a 6-month follow-up served as the study endpoints. Results: Regarding intestinal function and nutritional metabolism, the study group showed a significantly shorter time to first defecation (2.61 ± 1.45 days vs. 3.36 ± 1.48 days) and a shorter time to achieve stable enteral feeding (5.47 ± 2.62 days vs. 7.24 ± 2.93 days) compared to the control group (P < 0.05). The incidence of abdominal distension was also significantly lower in the study group (30.00% vs. 55.88%, P < 0.05), and serum albumin levels were higher (30.77 ± 5.26 g/L vs. 27.31 ± 4.22 g/L, P < 0.01). No statistically significant differences were found in the incidence of diarrhea or constipation between the groups. In terms of neurological prognosis, there were no significant differences in the Glasgow Outcome Scale (GOS) scores at 3 and 6 months post-discharge, or in the 6-month mortality rate (6.67% vs. 14.70%, P > 0.05) between the two groups. Conclusion: Early probiotic intervention effectively promotes the recovery of intestinal function and improves nutritional status in patients with severe TBI. However, within the follow-up period of this study, no significant improvement in neurological prognosis was observed.