血必净联合乌司他丁对坏死性小肠结肠炎新生儿炎性反应和心肌保护作用研究

Study on the Effect of Xuebijing Combined with Ulinastatin on Inflammatory Response and Myocardial Protection of Neonatus with Necrotizing Enterocolitis

目的:探讨血必净联合乌司他丁对坏死性小肠结肠炎(NEC)新生儿炎性反应和心肌的保护作用。方法:选取广东省妇幼保健院2019年5月~2022年5月期间收治的NEC新生儿120例。按照随机数字表法分为对照组(麻醉诱导前静脉泵注生理盐水)、乌司他丁组(麻醉诱导前静脉泵注乌司他丁注射液)、血必净组(麻醉诱导前静脉泵注血必净注射液)、联合组(麻醉诱导前静脉泵注乌司他丁注射液及血必净注射液),每组例数各为30例。对比四组新生儿的平均动脉压(MAP)、心率(HR)、白介素-17(IL-17)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、肌钙蛋白(cTnI)、B型钠尿肽(BNP)水平,记录四组死亡情况和不良反应发生率。结果:术前组间HR对比无统计学差异(P>0.05),乌司他丁组和血必净组较对照组在术毕和术后1 d下降,联合组较乌司他丁组和血必净组术毕和术后1 d下降明显(P<0.05)。术前组间MAP对比无统计学差异(P>0.05),乌司他丁组和血必净组较对照组在术毕和术后1 d升高,联合组较乌司他丁组和血必净组术毕和术后1 d升高明显(P<0.05)。乌司他丁组、血必净组、联合组术毕、术后1 d CRP、IL-17、TNF-α低于对照组同时间点,且联合组低于乌司他丁组、血必净组同时间点(P<0.05)。乌司他丁组、血必净组、联合组术毕、术后1 d cTnI、BNP低于对照组,且联合组低于乌司他丁组、血必净组同时间点(P<0.05)。联合组死亡率较对照组和乌司他丁组、血必净组低。四组不良反应发生率对比无统计学差异(P>0.05)。结论:在NEC围术期使用血必净联合乌司他丁,有利于新生儿血流动力学稳定,可减轻新生儿的炎性反应,发挥心肌保护作用,降低临床死亡率。

Objective:To explore the effect of Xuebijing combine with ulinastatin on inflammatory response and myocardial pro-tection of neonatus with necrotizing enterocolitis(NEC).Methods:120 neonatus with NEC who were admitted to Guangdong Women and Children Hospital from May 2019 to May 2022 were selected.According to the random number table method,they were divided into control group(intravenous infusion of physiological saline before anesthesia induction),ulinastatin group(intravenous infusion of ulinas-tatin injection before anesthesia induction),Xuebijing group(intravenous infusion of Xuebijing injection before anesthesia induction),and combined group(intravenous infusion of ulinastatin injection and Xuebijing injection before anesthesia induction),with 30 cases of each group.The levels of mean arterial pressure(MAP),heart rate(HR),interleukin-17(IL-17),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),cardiac troponin(cTnI),and B-type natriuretic peptide(BNP)were compared of four groups of neonatus,and the mor-tality and incidence of adverse reactions of four groups were recorded.Results:There was no statistically significant difference of HR between groups before surgery(P>0.05),ulinastatin group and Xuebijing group showed that decreased compared with control group after surgery and 1 d after surgery,and combined group showed that significant decreased after surgery and Id after surgery compared with ulinastatin group and Xuebijing group(P<0.05).There was no statistically significant difference of MAP between groups before surgery(P>0.05),ulinastatin group and Xuebijing group showed that increased compared with control group after surgery and 1 d after surgery,and combined group showed that significant increased after surgery and 1 d after surgery compared with ulinastatin group and Xuebijing group(P<0.05).The CRP,IL-17,TNF-αofulinastatin group,Xuebijing group,and combined group after surgery and 1 d after surgery were lower than those of control group at the same time point,and combined group were lower than those of ulinastatin group and Xuebijing group at the same time point(P<0.05).The cTnl and BNP of ulinastatin group,Xuebijing group,and combined group after surgery and 1 d after surgery were lower than those of control group at the same time point,and combined group were lower than those of ulinastatin group and Xuebijing group at the same time point(P<0.05).The mortality of combined group was lower than that of control group,ulinastatin group,and Xuebijing group.There was no statistically significant difference of the incidence of adverse reactions of four groups(P>0.05).Conclusion:Perioperative use of Xuebijing combine with ulinastatin of NEC,which is beneficial for the hemodynamic stability of neonatus,can alleviate the inflammatory response of neonatus,exert myocardial protection effect,and reduce clinical mortality.