乌司他丁治疗新生儿坏死性小肠结肠炎的疗效观察

Therapeutic effect of ulinastatin on neonatal necrotizing enterocolitis

目的观察乌司他丁治疗新生儿坏死性小肠结肠炎(NEC)的有效性及安全性。方法选取2016年8月至2020年1月于西安市儿童医院新生儿重症医学科诊断为NEC的150例患儿为研究对象,其中进行常规内科治疗者为对照组(n=75),在常规内科治疗基础上加用乌司他丁治疗者为观察组(n=75),比较两组患儿治疗48h后临床症状改善、炎症指标[白介素6(IL-6)、白介素8(IL-8)、降钙素原(PCT)]及凝血功能[凝血酶原时间(PT)、部分凝血活酶时间(APTT)、D-二聚体]变化、影像学改变情况、不良反应及住院结局。结果与对照组同期相比,观察组治疗48h后腹胀、血便、肠鸣音减弱的比例均降低(χ^(2)值分别为12.698、7.352、5.441,P<0.05),IL-6、IL-8、PCT水平均降低(t值分别为2.490、2.841、2.572,P<0.05),PT、APTT、D-二聚体均降低(t值分别为4.156、7.170、1.985,P<0.05),超声及腹部X线异常患儿的比例均降低(χ^(2)值分别为3.972、6.700,P<0.05);两组出现白细胞减少、肝功能受损、注射局部发红或皮疹的比例差异无统计学意义(P>0.05);观察组死亡比例、手术治疗比例、住院时间、禁食时间均低于对照组,差异均有统计学意义(t/χ^(2)值分别为2.014、1.964、3.031、2.058,P<0.05)。结论乌司他丁治疗新生儿坏死性小肠结肠炎可改善NEC患儿预后,安全性较好。

Objective To investigate the efficacy and safety of ulinastatin in the treatment of neonatal necrotizing enterocolitis(NEC).Methods A total of 150 children diagnosed with NEC from August 2016 to January 2020 in the department of neonatal intensive care medicine,Xi′an Children′s Hospital were selected as research subjects.The control group(n=75)received routine medical treatment,and the observation group(n=75)received ulinastatin on the basis of routine medical treatment.The improvement of clinical symptoms,changes in inflammatory indicators[interleukin-6(IL-6),interleukin-8(IL-8),procalcitonin(PCT)]and coagulation function[prothrombin time(PT),activated partial thromboplastin time(APTT),D-dimer],imaging changes,adverse reactions and hospitalization outcomes after 48 hours of treatment were compared in the two groups.Results After 48 hours of treatment,the proportion of children with abdominal distension,bloody stool and bowel sound decreased in the observation group compared with those in the control group(χ^(2)=12.698,7.352 and 5.441,respectively,P<0.05).Meanwhile,IL-6,IL-8 and PCT were significantly decreased(t=2.490,2.841 and 2.572,respectively,P<0.05).The PT,APTT and D-dimer were decreased(t=4.156,7.170 and 1.985,respectively,P<0.05).The proportion of children with abnormal ultrasound and X-ray in the observation group was reduced(χ^(2)=3.972 and 6.700,respectively,P<0.05).There was no significant difference in the proportion of leukopenia,impaired liver function,local redness or rash between the two groups(P>0.05).The mortality rate,surgical treatment rate,hospital stay,and fasting time in the observation group were all lower than those in the control group(t/χ^(2)=2.014,1.964,3.031 and 2.058,respectively,P<0.05).Conclusion Ulinastatin in the treatment of neonatal necrotizing enterocolitis can improve the prognosis of children with NEC with good safety.