血必净治疗对新生儿坏死性小肠结肠炎炎性反应的影响

Clinical study on the effect of Xuebijing on necrotizing enterocolitis by inhibiting inflammatory mediators

目的评估血必净能否有效地降低坏死性小肠结肠炎(NEC)患儿心肌损伤和炎性反应,从而起到心肌保护和炎性抑制作用,改善患儿预后。方法选取2018年6月到2019年4月在我院行NEC剖腹探查新生儿80例,出生胎龄足月患者,出生体重3050~5100 g;日龄3~27 d;5 min Apgar评分大于8分。入选患儿分为两组:生理盐水组(NS组,40例,泵注生理盐水5 mL/kg泵注,40例)、血比净组(XBJ组,40例,给予血比净5 mL/kg泵注),分别在术前1 h、术毕即刻、术后12 h、24 h采取患儿静脉血标本,通过酶联免疫吸附测定(ELISA)法检测患儿血清IL-17、TNF-α及肌钙蛋白(cTnI)浓度水平,检测C反应蛋白(CRP)和脑钠肽(BNP);同时记录患儿各时间点的平均动脉压、心率、SpO_(2)、多巴胺用量、乳酸值、术后住院时间及28天死亡率。结果两组患者一般情况,手术时间比较差异无统计学意义(P>0.05),两组患儿术后住院时间比较差异有统计学意义(P<0.05),两组患儿的平均动脉压、心率、28天死亡率、SpO_(2)差异无统计学意义(P>0.05);两组患儿的多巴胺用量,乳酸值比较差异有统计学意义(P<0.05);两组患儿CRP、IL-17、TNF-α和肌钙蛋白(cTnI)、BNP的表达比较均有统计学意义(P<0.05)。结论血必净能降低NEC患儿血清IL-17、TNF-α、cTnI及BNP的表达,缩短住院时间,推测与降低炎症反应、保护心肌有关。

Objective To evaluate whether Xuebijing can effectively reduce the myocardial injury and inflammatory response in children with necrotizing enterocolitis(NEC),so as to protect the myocardium and inhibit the inflammatory effect and improve the prognosis of children.Methods A total of 80 neonates with gestational age and full term birth weight of 3050~5100 g were selected from our hospital from June 2018 to April 2019 for NEC laparotomy,with 3 to 27 days of age and 5 min Apgar score over8 points.The enrolled children were divided into two groups:In this study,venous blood samples were collected 1 h before surgery,immediately after surgery,12 h and 24 h after surgery.In the control group(N group was pumped with normal saline 5 mL/kg,40 cases),and in the blood sample group(40 cases were given 5 m L/kg of blood pump).Serum levels of IL-17,TNF-αand troponin(cTnI)were detected by enzyme-linked immunosorbent assay(ELISA),and brain natriuretic peptide(BNP)was detected by immunosuppression assay and C-reactive protein(CRP)by turbidity immunoassay.Mean arterial pressure,heart rate,SpO_(2),dopamine dosage,lactic acid level,length of postoperative hospital stay and28-day mortality were recorded at each time point.Results There was no significant difference between the two groups in terms of general condition and operation time(P<0.05),and there was significant difference in postoperative hospital stay between two groups(P<0.05),there were no significant differences in mean arterial pressure,heart rate,28-day mortality and Sp O_(2) between two groups(P<0.05);There were statistically significant differences in the amount of dopamine and lactic acid between two groups.The expressions of CRP,IL-17,TNF-α,troponin(c Tn I)and BNP in two groups were statistically significant(P<0.001).Conclusion Xuebijing can reduce the expression of IL-17,TNF-α,c Tn I and BNP in serum of NEC children,shorten the length of hospital stay,which is speculated to be related to the reduction of inflammatory response and the protection of myocardium.