目的 探讨生长抑素对急腹症患儿术后胃肠功能及应激水平的影响。 方法 选取2019年8月至2021年6月徐州市儿童医院收治的行手术治疗的102例急腹症患儿为研究对象。将患儿随机分为观察组和对照组，每组各51例。对照组患儿术后给予止血、抗感染等常规治疗，观察组在常规治疗的基础上加用生长抑素。术前、术后第1天及术后第5天采集两组患儿外周血，比较两组患儿血清血管内皮素-1（endothelin-1，ET-1）、促肾上腺皮质激素（adrenocorticotropic hormone，ACTH）、皮质醇（cortisol，Cor）及胃泌素、胃动素水平，以及两组患儿术后恢复情况及并发症发生率。 结果 术前两组患儿血清ET-1、ACTH、Cor、胃动素及胃泌素水平差异无统计学意义（P>0.05）。术后第1天、第5天，观察组患儿血清ET-1、ACTH、Cor水平均显著低于对照组（P<0.05）；术后第5天，观察组患儿胃动素与胃泌素水平均高于对照组（P<0.05）。术后观察组患儿首次肛门排气时间、肠鸣音恢复时间、首次排便时间、住院时间均较对照组缩短（P<0.05）。观察组并发症发生率（6%）显著低于对照组（24%，P<0.05）。 结论 生长抑素可显著降低急腹症患儿术后应激反应，改善胃肠功能，降低并发症发生率，有益于疾病预后。
Abstract
Objective To study the effect of somatostatin on postoperative gastrointestinal function and stress level in children with acute abdomen. Methods A total of 102 children with acute abdomen who underwent surgery in Xuzhou Children's Hospital from August 2019 to June 2021 were enrolled as subjects and were randomly divided into an observation group and a control group, with 51 children in each group. The children in the control group were given conventional treatment such as hemostasis and anti-infective therapy after surgery, and those in the observation group were given somatostatin in addition to conventional treatment. Peripheral blood samples were collected from both groups before surgery and on days 1 and 5 after surgery. The two groups were compared in terms of the serum levels of endothelin-1 (ET-1), adrenocorticotropic hormone (ACTH), cortisol, gastrin, and motilin, postoperative recovery, and the incidence rate of complications. Results There was no significant difference in the serum levels of ET-1, ACTH, cortisol, gastrin, and motilin between the two groups before surgery (P>0.05). Compared with the control group, the observation group had significantly lower serum levels of ET-1, ACTH, and cortisol on days 1 and 5 after surgery (P<0.05) and significantly higher levels of motilin and gastrin on day 5 after surgery (P<0.05). Compared with the control group, the observation group had significantly shorter time to first passage of flatus, first bowel sounds, and first defecation after surgery, as well as a significantly shorter length of hospital stay (P<0.05). The incidence rate of complications in the observation group was significantly lower than that in the control group (6% vs 24%, P<0.05). Conclusions In children with acute abdomen, somatostatin can significantly reduce postoperative stress response, improve gastrointestinal function, and reduce the incidence rate of complications, thereby helping to achieve a good prognosis.
关键词
急腹症 /
生长抑素 /
腹部手术 /
胃肠功能 /
应激反应 /
儿童
Key words
Acute abdomen /
Somatostatin /
Abdominal surgery /
Gastrointestinal function /
Stress response /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
1 Reimer RP, Heneweer C, Juchems M, et al. Imaging in the acute abdomen—part 1 : case examples of frequent organ-specific causes: liver, gallbladder, pancreas, spleen and vessels[J]. Radiologe, 2021, 61(5): 497-510. PMID: 33860818. DOI: 10.1007/s00117-021-00843-1.
2 Li WJ, Gao C, An LX, et al. Perioperative transcutaneous electrical acupoint stimulation for improving postoperative gastrointestinal function: a randomized controlled trial[J]. J Integr Med, 2021, 19(3): 211-218. PMID: 33495134. DOI: 10.1016/j.joim.2021.01.005.
3 Mohammed AR, Eid AR, Elzehery R, et al. Effect of oropharyngeal administration of mother's milk prior to gavage feeding on gastrin, motilin, secretin, and cholecystokinin hormones in preterm infants: a pilot crossover study[J]. JPEN J Parenter Enteral Nutr, 2021, 45(4): 777-783. PMID: 32458450. DOI: 10.1002/jpen.1935.
4 Corbett B, Luz S, Sotuyo N, et al. FTY720 (Fingolimod), a modulator of sphingosine-1-phosphate receptors, increases baseline hypothalamic-pituitary adrenal axis activity and alters behaviors relevant to affect and anxiety[J]. Physiol Behav, 2021, 240: 113556. PMID: 34390688. DOI: 10.1016/j.physbeh.2021.113556.
5 Derella CC, Blanks AM, Wang X, et al. Endothelin receptor blockade blunts the pressor response to acute stress in men and women with obesity[J]. J Appl Physiol (1985), 2022, 132(1): 73-83. PMID: 34762528. PMCID: PMC8742738. DOI: 10.1152/japplphysiol.00156.2021.
6 祁伯祥, 朱磊, 商磊, 等. 生长抑素治疗新生儿术后消化道出血的疗效及安全性研究[J]. 中国当代儿科杂志, 2016, 18(11): 1065-1068. PMID: 27817766. PMCID: PMC7389866. DOI: 10.7499/j.issn.1008-8830.2016.11.002.
7 Mao X, Yang Z. Current usage status of somatostatin and its analogs and trypsin inhibitors: a real-world study of 34,654 Chinese adult patients with acute pancreatitis[J]. Ann Palliat Med, 2021, 10(2): 1325-1335. PMID: 33040552. DOI: 10.21037/apm-19-363.
8 Wu Z, Wang S, Yuan S, et al. Clinical efficacy and safety of somatostatin in the treatment of early postoperative inflammatory small bowel obstruction: a protocol for systematic review and meta analysis[J]. Medicine (Baltimore), 2020, 99(20): e20288. PMID: 32443374. PMCID: PMC7253791. DOI: 10.1097/MD.0000000000020288.
9 余东海, 张文, 冯杰雄, 等. 经脐腹腔镜在小儿急腹症中的应用[J]. 中华小儿外科杂志, 2013, 34(8): 586-589. DOI: 10.3760/cma.j.issn.0253-3006.2013.08.007.
10 周保东, 徐宏磊, 赵三鹏, 等. 基层医院1979例急腹症的病种类型和诊治回顾性分析[J]. 中国中西医结合外科杂志, 2019, 25(5): 809-812. DOI: 10.3969/j.issn.1007-6948.2019.06.035.
11 Boeckxstaens GE, de Jonge WJ. Neuroimmune mechanisms in postoperative ileus[J]. Gut, 2009, 58(9): 1300-1311. PMID: 19671558. DOI: 10.1136/gut.2008.169250.
12 Garabadu D, Shah A, Singh S, et al. Protective effect of eugenol against restraint stress-induced gastrointestinal dysfunction: potential use in irritable bowel syndrome[J]. Pharm Biol, 2015, 53(7): 968-974. PMID: 25473818. DOI: 10.3109/13880209.2014.950674.
13 Wen Z, Shen M, Wu C, et al. Chewing gum for intestinal function recovery after caesarean section: a systematic review and meta-analysis[J]. BMC Pregnancy Childbirth, 2017, 17(1): 105. PMID: 28415967. PMCID: PMC5394625. DOI: 10.1186/s12884-017-1286-8.
14 Zhou Y, Wang S. Efficacy of Jianpiyangxue granule on gastrointestinal autonomic nerve dysfunction and its impact on adverse reactions[J]. Am J Transl Res, 2021, 13(11): 12929-12938. PMID: 34956508. PMCID: PMC8661209.
15 Mohammed AR, Eid AR, Elzehery R, et al. Effect of oropharyngeal administration of mother's milk prior to gavage feeding on gastrin, motilin, secretin, and cholecystokinin hormones in preterm infants: a pilot crossover study[J]. JPEN J Parenter Enteral Nutr, 2021, 45(4): 777-783. PMID: 32458450. DOI: 10.1002/jpen.1935.
16 Ren X, Wang Y, He Z, et al. Effects of cefuroxime axetil combined with Xingpi Yanger granules on the serum gastrin, motilin, and somatostatin levels in children with upper respiratory tract infection accompanied by diarrhea: results of a randomized trial[J]. Transl Pediatr, 2021, 10(8): 2106-2113. PMID: 34584881. PMCID: PMC8429862. DOI: 10.21037/tp-21-314.
17 Ou M, Zhao H, Ji G, et al. Long noncoding RNA MALAT1 contributes to pregnancy-induced hypertension development by enhancing oxidative stress and inflammation through the regulation of the miR-150-5p/ET-1 axis[J]. FASEB J, 2020, 34(5): 6070-6085. PMID: 32246794. DOI: 10.1096/fj.201902280R.
18 Fang H, Hu S, Liang S, et al. The clinical value of high-quality nursing in concurrent radiotherapy and chemotherapy after glioma surgery and its influence on the stress indicators Cor, ACTH, and CRP[J]. J Healthc Eng, 2022, 2022: 8335400. PMID: 35126950. PMCID: PMC8808127. DOI: 10.1155/2022/8335400.
19 董琦, 张京. 小儿腹部手术后应用生长抑素的疗效观察[J]. 中国现代医学杂志, 2017, 27(26): 106-109. DOI: 10.3969/j.issn.1005-8982.2017.26.022.
20 Li T, Xiang PLB. Therapeutic effects of endoscopic mucosal resection on the recovery and prognosis of early gastric cancer[J]. J BUON, 2019, 24(3): 1087-1091. PMID: 31424665.
PDF(529 KB)
