护理讲课_微生态学粪菌移植.pptVIP

2013年文献报道，第一个粪便移植治疗复发性CDI患者的随机对照研究显示，单次鼻胃管注入FMI成功率是81%。第二次鼻胃管注入的成功率高达94%，而万古霉素（500mg qid）治疗2周伴有或没有灌肠的情况下有效率仅23%-31%，经过FMI治疗后，肠道菌群种类明显增加，主要有拟杆菌种属、梭菌种属IV及XIVa型。而变形杆菌则减少。除了与灌肠相关的轻度腹泻外，无显著不良事件发生。得出FMI的治疗及成功率各有差异性。 美国胃肠病学推荐：FMT作为复发CDI治疗方式。 粪菌移植的疗效及安全性 Main case series and reports of fecal microbiota transplantation in inflammatory bowel disease treatment Ref. IBD type ( n ) Stool material Volume infusion Infusionroute Frequency Donor relationship Characteristics of outcomes Bennet et al [34] , 1989 UC (1) NR NR Enema 1 NR Documents remission for 6 mo and ceasemedications Borody et al [144] , 1989 UC (1) NR NR Enema NR NR Documents remission for 3 mo and ceasemedications Borody et al [35] , 2003 UC (6) Fresh 200-300g/200-300 mL Enema 6 Related or unrelated Documented remission from 1 to 13 yr andcease medications Hamilton et al [112] , 2012 UC combinedwith CDI (4) Fresh orfrozen 220-240 mL Colonoscopy 1 Related or unrelated Colitis activity was improved, and CDI wascured Zainah et al [145] , 2012 UC combinedwith CDI (1) Fresh 300 mL Colonoscopy 1 Related Documented symptom-free for 8 mo withoutCDI recurrence Borody et al [146] , 2012 UC (3) Fresh NR Repeatedrectal infusions Daily infusion for2 to 6.5 mo Related or unrelated Documented improvement from 1 to 36 mo Patel et al [147] , 2013 UC combinedwith CDI (3) Fresh 18-397 g/180-600 mL Colonoscopy 1 Related or unrelated Symptoms such as diarrhea improved orresolved 3 mo after FM Angelberger et al [105] , 2013 UC (5) Fresh 17-25 g/250mL+6-12 g/100 mL Nasojejunaltube + enema 3 Unrelated None of cases achieved remission, but onlyone case was response to FMT by week 12;two cases deteriorated 4 wk after FMT Kump et al [148] , 2013 UC (6) Fresh 300-500 mL Colonoscopy 1 Unrelated Documented improvement, but no remissionwithin 2 wk after FMT De Leon et al [110] , 2013 UC combinedwith CDI (1) Fresh 600 mL Colonoscopy 1 Related UC relapse 9 d after FMT Main case series and reports of fecal microbiota transplantation in inflammato