目的：研究腹部按摩联合枯草杆菌二联活菌对重型创伤性脑损伤(sTBI)患者胃肠道排空功能的影响。方法：采用随机数字表法，将纳入的sTBI患者分为实验组(腹部按摩联合枯草杆菌二联活菌)与对照组(仅腹部按摩)。收集患者的基线资料及胃肠道排空相关指标，干预两周后运用光冈法计数两组患者新鲜大便中的肠道菌群数，并比较两组间的差异。结果：共112例患者完成了研究，其中实验组55例，对照组57例。两组基线资料比较，差异无统计学意义(P>0.05)。和对照组比较，实验组首次排便时间短、排便量多及便秘、腹泻、呕吐发生率低，差异均具有统计学意义(均P<0.05)。和对照组比较，实验组双歧杆菌(7.41±1.12 vs. 6.36±0.87)及乳酸杆菌(6.48±0.74 vs. 5.23±0.61)明显增多，而大肠杆菌(7.63±0.74 vs. 8.84±1.20及葡萄球菌(2.41±0.36 vs. 3.20±0.39)减少，差异均有统计学意义(均P<0.001)。结论：腹部按摩联合枯草杆菌二联活菌是调节sTBI患者肠道微生态和促进胃肠道排空的有效方案。

[1] 胡锦.重视重型创伤性脑损伤的早期规范化救治[J].中华创伤杂志,2019,35(3):199-203.
[2] MAAS A I R,MENON D K,ADELSON P D,et al.Traumatic brain injury:integrated approaches to improve prevention,clinical care,and research[J].Lancet Neurol,2017,16(12):987-1048.
[3] DEHGHAN M,FATEHI A,MEHDIPOOR R,et al.Does abdominal massage improve gastrointestinal functions of intensive care patients with an endotracheal tube a randomized clinical trial?[J].Complement Ther Clin Pract,2018,30:122-128.
[4] KARADAG A S.Evaluation of constipation risk among inpatients insurgery and internal medicine wards[J].Turk J Colorectal Dis,2019,29:19-24.
[5] ARI M,YILMAZ E.Impact of pre-operative anxiety on post-operative constipation[J].Turk J Colorectal Dis,2016,26:39-46.
[6] ALTUN UGRAS G,YUKSEL S.Factors affecting intracranial pressure and nursing interventions[J].Jacobs J Nurs Care,2014,1:1-6.
[7] HAY T,BELLOMO R,RECHNITZER T,et al.Constipation,diarrhea,and prophylactic laxative bowel regimens in the critically ill:a systematic review and meta-analysis[J].J Crit Care,2019,52:242-250.
[8] TURAN N,ATABEK A T.The effect of abdominal massage on constipa-tion and quality of life[J].Gastroenterol Nurs,2016,39:48-59.
[9] PARTHASARATHY G,CHEN J,CHEN X,et al.Relationship between microbiota of the colonic mucosa vs feces and symptoms,colonic transit,and methane production in female patients with chronic constipation[J].Gastroenterology,2016,150(2):367-379.
[10] 葛均波,徐永健.内科学[M].8版.北京:人民卫生出版社,2013:402-407.
[11] HEINONEN T,FERRIE S,FERGUSON C.Gut function in the intensive care unit-what is normal?[J].Aust Crit Care,2020,33:151-154.
[12] FENNESSY G J,WARRILLOW S J.Gastrointestinal problems in intensive care[J].Anaesth Intensive Care Med,2015,16:165-170.
[13] TURAN N,KAYA H.Management of constipation in neurosurgery patients[J].J Neurol Neurosurg Nurs.2014,3:81-87.
[14] FUKUDA S,MIYAUCHI T,FUJITA M,et al.Risk factors for late defecation and its association with the outcomes of critically ill patients:a retrospective observational study[J].J Intensive Care,2016,33:1-8.
[15] GUERRA T L,MENDONÇA S S,MARSHALL N G.Incidence of constipation in an intensive care unit[J].Rev Bras TerIntensiva,2013,25:87-92.
[16] GACOUIN A,CAMUS C,GROS A,et al.Constipation in long-term ventilated patients:associated factors and impact on intensive care unit outcomes[J].Crit Care Med,2010,38:1933-1938.
[17] 俞大方.推拿学[M].上海:上海科学技术出版社,1999:9-15.
[18] MCCLURG D,GOODMAN K,HAGEN S,et al.Abdominal massage for neurogenic bowel dysfunction in people with multiple sclerosis (AMBER Abdominal Massage for Bowel Dysfunction Effectiveness Research):study protocol for a randomised controlled trial[J].Trials,2017,18:1-9.
[19] TURAN N,ATABEK A T.The effect of abdominal massage on constipation and quality of life[J].Gastroenterol Nurs,2016,39:48-59.
[20] ZOPPI G,CINQUETTI M,LUCIANO A.The intestinal ecosystem in chronic functional constipation[J].Acta Paediatr,1998,87,836-841.
[21] 裴婷娜.益生菌活菌制剂联合肠内营养治疗重症脑卒中患者的临床效果[J].中国药物经济学,2016,11(11):51-52.