目的 探讨小剂量多巴胺辅助治疗对坏死性小肠结肠炎（NEC）早产儿炎症因子及预后的影响。方法 将2017年6月至2019年6月住院治疗的NEC早产儿100例，依据随机数字表法分为多巴胺治疗组（多巴胺组）和常规治疗组（常规组），每组50例。常规组给予常规对症治疗，多巴胺组在常规治疗基础上给予小剂量多巴胺辅助治疗。ELISA法检测两组C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白介素-8（IL-8）水平；观察并记录两组患儿临床症状缓解时间、禁食时间、治疗疗效、预后及不良反应。结果 多巴胺组和常规组治疗后CRP、TNF-α、IL-8水平均明显低于治疗前，多巴胺组治疗后CRP、TNF-α、IL-8水平均明显低于常规组（P < 0.05）；多巴胺组大便改善时间、腹胀及腹泻缓解时间、禁食时间均明显短于常规组（P < 0.05）；多巴胺组治疗有效率明显高于常规组，手术率明显低于常规组（P < 0.05）；两组病死率、不良反应发生率比较差异无统计学意义（P > 0.05）。结论 小剂量多巴胺辅助治疗可有效改善NEC早产儿炎症因子水平及临床症状，有利于提高患儿治疗疗效，且安全性好，值得临床推广。
Abstract
Objective To study the effect of low-dose dopamine adjuvant therapy on inflammatory factors and prognosis in preterm infants with necrotizing enterocolitis (NEC). Methods A total of 100 preterm infants with NEC from June 2017 to June 2019 were enrolled and divided into a dopamine treatment group and a conventional treatment group using a random number table, with 50 infants in each group. The infants in the conventional treatment group were given symptomatic treatment, and those in the dopamine treatment group were given low-dose dopamine adjuvant therapy in addition to the conventional treatment. ELISA was used to measure the levels of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-8 (IL-8). The two groups were compared in terms of time to relief of clinical symptoms, fasting time, treatment outcome, prognosis, and adverse reactions. Results Both groups had significant reductions in the levels of CRP, TNF-α, and IL-8 after treatment, and the dopamine treatment group had significantly lower levels of these markers than the conventional treatment group after treatment (P < 0.05). Compared with the conventional treatment group, the dopamine treatment group had significantly shorter time to defecation improvement, time to relief of abdominal distension and diarrhea, and fasting time (P < 0.05), a significantly higher response rate (P < 0.05), and a significantly lower surgery rate (P < 0.05). There were no significant differences in the mortality rate and incidence of adverse events between the two groups (P > 0.05). Conclusions Low-dose dopamine adjuvant therapy can effectively improve the levels of inflammatory factors and clinical symptoms in preterm infants with NEC and has good safety, and therefore, it holds promise for clinical application.
关键词
坏死性小肠结肠炎 /
多巴胺 /
炎症因子 /
预后 /
早产儿
Key words
Necrotizing enterocolitis /
Dopamine /
Inflammatory factor /
Prognosis /
Preterm infant
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参考文献
[1] 谢淑霞. 谷氨酰胺辅助治疗早产儿坏死性小肠结肠炎的疗效及对患儿肿瘤坏死因子-α水平的影响[J]. 中国现代医生, 2019, 57(12):50-52.
[2] Wang ZL, Liu L, Hu XY, et al. Probiotics may not prevent the deterioration of necrotizing enterocolitis from stage I to II/III[J]. BMC Pediatr, 2019, 19(1):185.
[3] 王枫. 酚妥拉明联合小剂量多巴胺对新生儿坏死性小肠结肠炎患者手术率、疗效及临床不良反应的影响[J]. 中国生化药物杂志, 2017, 37(9):148-149.
[4] 陈永满, 徐渭贤, 孙立宝, 等. 乌司他丁联合康复新液胃管注入治疗新生儿坏死性小肠结肠炎疗效观察[J]. 现代中西医结合杂志, 2018, 27(11):1189-1191.
[5] Yuan Y, Ding D, Zhang N, et al. TNF-α induces autophagy through ERK1/2 pathway to regulate apoptosis in neonatal necrotizing enterocolitis model cells IEC-6[J]. Cell Cycle, 2018, 17(11):1390-1402.
[6] 邵肖梅, 叶鸿瑶, 丘小汕. 实用新生儿学[M]. 第4版. 北京:人民卫生出版社, 2011:805-810.
[7] Jin YT, Duan Y, Deng XK, et al. Prevention of necrotizing enterocolitis in premature infants-an updated review[J]. World J Clin Pediatr, 2019, 8(2):23-32.
[8] 周燕. 奥曲肽注射液治疗新生儿坏死性小肠结肠炎的临床研究[J]. 中国急救医学, 2017, 37(z1):233-234.
[9] De Bernardo G. Necrotizing enterocolitis:from diagnosis to therapy[J]. Curr Pediatr Rev, 2019, 15(2):67.
[10] 程波, 万诚, 张茜. 奥曲肽注射液治疗坏死性小肠结肠炎新生儿的临床研究[J]. 中国临床药理学杂志, 2017, 33(1):77-79.
[11] Shin SH, Kim EK, Lee KY, et al. TNF-α antagonist attenuates systemic lipopolysaccharide-induced brain white matter injury in neonatal rats[J]. BMC Neurosci, 2019, 20(1):45.
[12] 赵启晖, 李刚, 李梅, 等. 益生菌干预对患坏死性小肠结肠炎早产儿胃肠激素、炎症介质及Toll样受体4表达水平的影响分析[J]. 标记免疫分析与临床, 2017, 24(10):1154-1158.
[13] Martynov I, Raedecke J, Klima-Frysch J, et al. The outcome of Bishop-Koop procedure compared to divided stoma in neonates with meconium ileus, congenital intestinal atresia and necrotizing enterocolitis[J]. Medicine (Baltimore), 2019, 98(27):e16304.
[14] 刘春义, 范丽莉. 酚妥拉明联合多巴胺治疗新生儿坏死性小肠结肠炎的回顾性研究[J]. 河北医药, 2016, 38(17):2672-2674.
[15] Connelly J, Benani DJ, Newman M, et al. Systemic effects of low-dose dopamine during administration of cytarabine[J]. J Oncol Pharm Pract, 2017, 23(6):436-442.
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