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

Clinical effect and safety of somatostatin in treatment of postoperative gastrointestinal bleeding in neonates

摘要:

目的 观察生长抑素治疗新生儿术后消化道出血的临床疗效及安全性。方法 126例先天性消化道畸形术后的新生儿进行前瞻性随机分组，采用随机数字表分为对照组、治疗A组和治疗B组，对照组予以术后常规止血等治疗，治疗组在此基础上加用生长抑素，治疗A组生长抑素给药方式采用静脉推注0.25mg作为负荷量，随后予以0.25mg/h维持，而B组予以每小时3.5μg/kg持续静脉泵入。对3组患儿临床疗效及并发症等情况进行比较。结果 与对照组相比较，治疗组患儿胃肠减压引流液隐血试验转阴时间明显缩短，治疗后24h血红蛋白下降值减低 （P < 0.05），而治疗A组和治疗B组相比较差异无统计学意义。与对照组相比，治疗A组患儿治疗1h后心率 （HR）、呼吸 （RR）、血压 （BP）和动脉血氧饱和度 （SaO₂）减低 （P < 0.05），余时间点观察指标无显著差异；治疗B组各项监测指标均无明显差异。对照组患儿未见低血糖反应，治疗A组低血糖发生率为20%，显著高于治疗B组 （P < 0.05）。结论 生长抑素治疗新生儿术后消化道出血疗效显著，且总体安全性良好，以持续静脉给药方式不良反应为少。

Abstract:

Objective To investigate the clinical effect and safety of somatostatin in the treatment of postoperative gastrointestinal bleeding in neonates. Methods A prospective randomized study was performed, and 126 neonates who underwent surgery for congenital gastrointestinal anomalies were randomly divided into control group, treatment group A, and treatment group B. The neonates in the control group were given routine postoperative hemostasis, and those in the treatment groups were given somatostatin in addition to the treatment for the control group. The neonates in treatment group A were given intravenous injection of somatostatin 0.25 mg as the initial dose and 0.25 mg/h for maintenance, and those in treatment group B were given continuous intravenous pumping of somatostatin at a dose of 3.5 μg/ (kg·h). The clinical outcome and complications were compared between the three groups. Results Compared with the control group, the treatment groups had significantly shortened clearance time in occult blood test for gastrointestinal decompression drainage and a significantly lower degree of the reduction in 24-hour hemoglobin (P < 0.05), while there were no significant differences between treatment groups A and B. Compared with the control group, treatment group A had significant reductions in heart rate (HR), respiratory rate (RR), blood pressure (BP), and SaO₂ after one hour of treatment (P < 0.05), but there were no significant differences at the other time points between the two groups (P > 0.05). There were no significant differences in monitoring indices between the control group and treatment group B (P > 0.05). No neonates in the control group experienced hypoglycemia reaction, and treatment group A had a significantly higher incidence rate of hypoglycemia (20%) than treatment group B (P < 0.05). Conclusions Somatostatin has a marked clinical effect and good safety in the treatment of neonates with postoperative gastrointestinal bleeding, and the administration of somatostatin by continuous intravenous pumping leads to fewer side effects.