奥曲肽联合常规保守治疗Ⅰ期及Ⅱ期新生儿坏死性小肠结肠炎43例临床研究

Clinical Study on Octreotide Combined with Conventional Conservative Therapy in Treating 43 Cases of Phase Ⅰ,Ⅱ Neonatal Necrotizing Enterocolitis

目的探讨奥曲肽联合常规药物保守治疗Ⅰ期及Ⅱ期新生儿坏死性小肠结肠炎的临床疗效。方法选择2010年8月至2014年2月医院新生儿科收治的患儿86例,按照随机数字表法分为治疗组和对照组,各43例。两组均给予常规保守治疗,治疗组加用奥曲肽微泵静脉输注,每日1次,连续7 d。观察常规实验室检查结果的变化,测定肠道特异性标志物血浆肠脂肪酸结合蛋白(I-FABP)和粪钙卫蛋白(FC)水平。结果治疗1周后,治疗组总有效率为93.02%,明显高于对照组的81.40%(P<0.05);两组患儿血尿素氮、血浆总蛋白、血浆白蛋白均较治疗前无明显变化(P>0.05);血小板计数均明显升高(P<0.05),治疗组上升更明显(P<0.05);胆红素水平有所降低,但组间无明显差异;两组患者I-FABP和FC水平均较治疗前明显下降(P<0.05),且治疗组下降更明显(P<0.05);两组患者治疗前后血常规、尿常规、肝肾功能及心电图变化均在可接受范围内,且未见高血糖、胆石、糖耐受异常、胆汁淤积性并发症等其他不良反应。结论奥曲肽联合常规保守治疗Ⅰ期及Ⅱ期新生儿坏死性小肠结肠炎的疗效较传统保守治疗更可靠,且无明显不良反应,值得推广。

Objective To investigate the clinical efficacy of octreotide combined with conventional conservative therapy in treating phaseⅠ,Ⅱ neonatal necrotizing enterocolitis（NEC）. Methods 86 patients with phase Ⅰ,Ⅱ of neonatal NEC admitted to our hospital from August 2010 to February 2014 were selected and divided into the treatment group and the control group according to the random number table,43 cases in each group. The two groups were given the conventional conservative treatment. The treatment group was added with octreotide by intravenous moicropump infusion,once a day,for 7 d. The changes of blood,urine,fecal occult blood,liver and kidney function and ECG were observed. The intestinal specific marker plasma intestinal fatty acid binding protein（I- FABP） and fecal calprotectin（FC） levels were detected. Results The total effective rate after 1- week treatment in the treatment group was 93. 02%,which was significantly higher than 81. 40% in the control group（P〈0. 05）; the blood urea nitrogen,plasma total protein and albumin in the two groups had no obvious change compared with before treatment（P 〉0. 05）,the platelet in the two groups was significantly higher than before treatment,the treatment group was more nigher（P〈0. 05）,the bilirubin level was decreased to some extent（P〈0. 05）,but no significant difference betueen the two groups; plasma I- FABP and FC were significantly decreased compared with before treatment（P〈0. 05）,moreover the decrease in the treatment group was more significant than the control group（P〈0. 05）; the blood routine,urine routine,liver and kidney functions and ECG changes in the two groups were within the acceptable ranges without the complications of hyperglycemia,cholelithiasis,abnormal glucose tolerance,cholestatic and other adverse reactions. Conclusion The efficacy of octreotide combined with conventional conservative therapy in treating phase Ⅰ,Ⅱ neonatal NEC is more reliable without significant adverse reactions than the traditional conservative treatment,which is worthy of promotion.