粪菌移植与重症课件

CasepresentationA44-year-oldwoman，proximalgastrectomyandbilateraltruncalvagotomyforagastricneuroendocrinetumorthethirddaybloating,nauseaandvomitingthefourthday,waterydiarrhea.BP60/38mmHgLac8.2mmol/L

transferredtoICUthefifthday,39.6℃,ARDS,intubation,diarrheawasaggravated,greenish,wateryliquidexceeding1,800ml.septicshock,Sulbactam,ornidazole,NE.->VV-ECMO+CRRTConditiongraduallystabilized.VV-ECMOandCRRTwerestoppedonthe12thday,butdiarrheadidnotshownanyimprovement.Bloodcultures:Acinetobacterbaumannii

andEnterococcusfaecalis

->Imipenem,caspofungin,penicillinand/orlinezolid.Antibioticswerecontinueduntil28days,stillhadafever(38.3℃)waterystoolsreached2,855ml.bloodculture:Propionibacteriumacnes(疮疱丙酸杆菌)

CRP103.3mg/LCasepresentationCasepresentationCasepresentation健康人患者FecalmicrobiotatransplantationCriticalCare(2015)19:37CriticalCare(2015)19:37CriticalCare(2015)19:37CriticalCare(2015)19:37ImmunomodulatoryeffectCriticalCare(2015)19:37Thisreportprovidesa

wonderfulexampleofaproof-of-conceptstudyindicatingthatFMTmayrepresentanidealtherapeuticalternative

tocontrolsystemicinflammationinpatientswithsepsis.CriticalCare(2015)19:37FecalMicrobiotaTransplantation

粪菌移植过去野葛芋毒、山中毒菌欲死者，并饮粪汁一升，即活。明朝李时珍所著《本草纲目》，记载用人粪治病的疗方多达二十多种，也强调了发酵粪便上清液和新鲜粪清。现代的发展1958年，美国Eiseman首次报道FMT用于治疗人伪膜性肠炎。1983年，瑞典Schwan首次报道通过灌肠FMT治疗CDI获得很好疗效1989年，Bennet和Brinkman首次报道FMT治疗UC取得了很好的疗效2013年，NEJM发文示FMT治疗复发性CDI的临床对照研究证明FMT的疗效显著优于万古霉素。《Science》和《TIME》将其评为2013年生物医学的十大突破之一。Gastroenterology,2013,145(5):946-953目前的应用小儿自闭症Gastroenterology,2013,145(5):946-953Freshstoolsamplesfromhealthydonorsweretransportedtotheprocessinglaboratorieswithin5hoursofcollectionandstoredat5°CuntilfrozenorusedforFMT.Frozensuspensionswerekeptat−20°Cforamaximumof30daysandthawedovernightat25℃.CONCLUSIONS：AmongadultswithrecurrentorrefractoryCDI,theuseoffrozencomparedwithfreshFMTdidnotresultinworseproportionofclinicalresolutionofdiarrhea.GiventhepotentialadvantagesofprovidingfrozenFMT,itsuseisareasonableoptioninthissetting.JAMA.2016;315(2):142-149.不良事件Gastroenterology

2015;149:223–237我们不知道的Wedonotknowthepossiblelong-termsequelaeofchangingthemicrobiota,orevenifit