生长抑素联合红霉素对腹部损伤患者术后恢复和免疫指标的影响

摘要

目的 观察生长抑素联合红霉素对腹部损伤术后胃肠功能、机体免疫指标的影响.方法 选取2014年1月—2016年12月河北北方学院附属第一医院普通外科手术治疗腹部损伤患者90例作为研究对象,随机数字表法分为对照组30例、单药组30例和联合组30例.对照组术后常规给予吸氧、胃肠减压、营养支持和纠正水电解质平衡处理等治疗,单药组在此基础上给予红霉素治疗,联合组则再辅以生长抑素和红霉素治疗.记录3组患者肠鸣音恢复、首次排气、排便、平均住院时间;观察术后1d、3d、5d胃肠减压管引流量;检测术前及术后第1天、5天血清IgA、IgG、IgM、CD3+、CD4+、CD8+水平.结果 联合组术后肠鸣音恢复、首次排气、排便、平均住院时间均明显<单药组<对照组,差异均有统计学意义(F=4.384、2.989、3.022、2.557,P<0.01);3组术后第1天胃肠减压管引流量无明显差异(P>0.05),术后第3天、5天,联合组<单药组<对照组,差异有统计学意义(F=5.186、3.137,P<0.01);3组术前血清IgA、IgG、IgM、CD3+、CD4+、CD8+水平无明显差异(P>0.05),术后第1天3组患者血清IgA、IgG、IgM、CD3+、CD4+、CD8+水平较术前均明显下降,差异均有明显统计学意义(P<0.05),下降程度联合组<单药组<对照组,术后5天3组各项免疫指标均开始上升,联合组已趋于术前,但单药组和对照组仍低于术前水平(P<0.05).联合组术后并发症发生率低于单药组和对照组,差异有统计学意义(χ2=5.528,P=0.021).结论 生长抑素联合红霉素对腹部损伤术后免疫功能影响较小,能提高机体免疫力,促进快速康复.%Objective To discuss the clinical effect and immune index of somatostatin combined with erythromycin in patients with abdominal injury operation.Methods Clinical data of 90 patients with abdominal injury treated by operation from January 2015 to December 2016 in the Dept.of General Surgery of The First Affiliated Hospital of Hebei North University were selected and randomly divided into the control group(30 cases), the single group(30 cases), and the combination group(30 cases).The patients in the control group were treated by oxygen absorption,gastrointestinal decompression,nutri-tion support and water electrolyte balance correction.The patients in the single group were treated with erythromycin in the ba-sis of convention treatment,and the patients in the combination group were treated with somatostatin combined with erythromy -cin in the basis of convention treatment.The postoperative recovery(the recovery time of bowel sounds,the first exhaust time, first defecation time,average time of hospital)were recorded.The discharge amount of gastrointestinal decompression of post-operative 1d,3d and 5d and the immune function before surgery and postoperative 1 and 5d were detected.Results The re-covery time of bowel sounds, the first exhaust time, first defecation time, average time of hospital in the combination group were significantly earlier than those in the control group and the single group,the above index in the single group were signifi-cantly earlier than those in the control group, and there was statistical differences(F=4.384, F=2.989, F=3.022, F=2.557,P<0.01).There was no differences among the three groups in the discharge amount of gastrointestinal decompression of postoperative 1d(P>0.05).There were statistical differences among the three groups in the discharge amount of gastrointestinal decompression of postoperative 3d and 5d(F=5.186,F=3.137,P<0.01)(the combination group 0.05).The above immune index of postoperative 1d were significantly lower than those before oper-ation in the three groups,but the control group decreased more significantly(P<0.05).The above immune index of postop-erative 5d were gradually increased,but the combination group increased more significantly(P<0.05).The complications incidence in the combination group was lower than those in the control group and the single group with statistical differences (F=5.528,P=0.021)Conclusion Somatostatin combined with erythromycin have impact on the immune function,it can improve the body immunity,promote recovery.