生长抑素对重症消化道术后婴儿胃肠激素水平和临床预后的影响：一项前瞻性随机对照研究

Effect of somatostatin on gastrointestinal hormone levels and clinical outcomes in critically ill infants after gastrointestinal surgery: a prospective randomized controlled study

摘要:

目的 探讨生长抑素对重症消化道术后婴儿胃肠激素水平和临床预后的影响。方法 采用随机数字表法将2019年6月—2021年6月入住徐州市儿童医院外科重症监护室的重症消化道术后婴儿随机分为观察组（29例）和对照组（30例）。对照组术后给予抗感染、止血等常规治疗，观察组在常规治疗的基础上加用生长抑素（每小时3.5 μg/kg持续静脉泵入，连用7 d）。比较两组婴儿术前、术后第3天及术后第7天血清胃泌素（gastrin, GAS）、胃动素（motilin, MTL）、胰岛素、胰高血糖素样肽-1（glucagon-like peptide-1, GLP-1）水平，以及两组婴儿术后恢复情况及并发症的发生率。结果 两组术前血清GAS、MTL、胰岛素、GLP-1水平差异无统计学意义（P>0.05）。观察组术后第3天和第7天血清GAS、MTL、胰岛素和GLP-1水平高于对照组（P<0.05）；观察组GAS、MTL、胰岛素和GLP-1水平术后第7天高于术前和术后第3天（P<0.05），术后第3天高于术前（P<0.05）。对照组术前、术后第3天及术后第7天血清GAS、MTL、胰岛素水平差异无统计学意义（P>0.05）；GLP-1水平术后第7天高于术前和术后第3天（P<0.05），术后第3天高于术前（P<0.05）。观察组术后首次肛门排气时间、肠鸣音恢复时间、首次排便时间均较对照组缩短（P<0.05）；观察组术后并发症发生率低于对照组（10% vs 33%，P<0.05）。结论 生长抑素可提高重症消化道术后婴儿血清GAS、MTL、胰岛素及GLP-1的水平，加快患儿胃肠功能的恢复，并可降低术后并发症的发生率。

Abstract:

Objective To explore the effects of somatostatin on the levels of gastrointestinal hormones and clinical outcomes in critically ill infants after gastrointestinal surgery.Methods Using a random number table method, critically ill infants after gastrointestinal surgery who were admitted to the Intensive Care Unit of Xuzhou Children's Hospital from June 2019 to June 2021 were randomly divided into an observation group (29 cases) and a control group (30 cases). The control group received routine treatment such as anti-infection and hemostasis after surgery, while the observation group received somatostatin in addition to the routine treatment [3.5 μg/(kg·h) infusion for 7 days]. The levels of serum gastrin (GAS), motilin (MTL), insulin, and glucagon-like peptide-1 (GLP-1) before surgery, on the 3rd day after surgery, and on the 7th day after surgery were compared between the two groups. The recovery progress and incidence of complications after surgery were also compared between the two groups.Results There was no significant difference in the levels of serum GAS, MTL, insulin, and GLP-1 between the two groups before surgery (P>0.05). On the 3rd and 7th day after surgery, the levels of serum GAS, MTL, insulin, and GLP-1 in the observation group were higher than those in the control group (P<0.05). In the observation group, the levels of GAS, MTL, insulin, and GLP-1 on the 7th day after surgery were higher than those before surgery and on the 3rd day after surgery (P<0.05), and the levels on the 3rd day after surgery were higher than those before surgery (P<0.05). There was no significant difference in the levels of serum GAS, MTL, and insulin before surgery, on the 3rd day after surgery, and on the 7th day after surgery in the control group (P>0.05). The level of GLP-1 on the 7th day after surgery was higher than that before surgery and on the 3rd day after surgery (P<0.05), and the level on the 3rd day after surgery was higher than that before surgery (P<0.05) in the control group. The observation group had shorter first time of anal exhaust, recovery time of bowel sounds, and first time of defecation after surgery compared to the control group (P<0.05). The incidence of complications after surgery in the observation group was lower than that in the control group (10% vs 33%, P<0.05).Conclusions Somatostatin can increase the levels of serum GAS, MTL, insulin, and GLP-1 in critically ill infants after gastrointestinal surgery, promote the recovery of gastrointestinal function, and reduce the incidence of postoperative complications.