目的 探討枯草桿菌二聯(lián)活菌顆粒聯(lián)合美羅培南治療新生兒壞死性小腸結(jié)腸炎的有效性和安全性。方法 選取2020年1月—2021年12月天津市兒童醫(yī)院收治的70例新生兒壞死性小腸結(jié)腸炎患兒，采用隨機(jī)數(shù)字表法將其分為對(duì)照組（35例）和治療組（35例）。對(duì)照組靜脈滴注注射用美羅培南，20 mg/kg溶解于5～10 mL生理鹽水中，日齡≤7 d患兒12 h/次，日齡＞7 d患兒8 h/次。治療組在對(duì)照組基礎(chǔ)上口服枯草桿菌二聯(lián)活菌顆粒，1袋/次，2次/d。兩組患兒治療7 d。觀察兩組患兒臨床療效，比較治療前后兩組患兒腸道菌群變化，CD4^＋、CD8^＋、CD4^＋/CD8^＋值及臨床癥狀改善情況。結(jié)果 治療后，治療組患兒總有效率97.14%較對(duì)照組的82.86%顯著增加（P＜0.05）。治療后，兩組患兒桿菌總數(shù)、球菌總數(shù)、球桿菌比值及CD4^＋、CD4^＋/ CD8^＋值均顯著高于治療前（P＜0.05），且治療組患兒明顯高于對(duì)照組（P＜0.05）。治療后，兩組患兒CD8^＋顯著低于治療前（P＜0.05），且治療組患兒明顯低于對(duì)照組（P＜0.05）。治療組患兒嘔吐緩解時(shí)間、腹脹緩解時(shí)間及大便次數(shù)性狀復(fù)常時(shí)間均明顯早于對(duì)照組（P＜0.05）。結(jié)論 枯草桿菌二聯(lián)活菌顆粒聯(lián)合美羅培南治療新生兒壞死性小腸結(jié)腸炎具有較高療效和安全性，可加速患兒腸道益生菌繁殖生長(zhǎng)，改善患兒免疫功能。

Objective To investigate the efficacy and safety of Combined Bacillus Subtilis and Enterococcus Faecium Granules with Multivitamines, Live combined with meropenem in treatment of neonatal necrotizing enterocolitis. Methods Children (70 cases) with neonatal necrotizing enterocolitis in Tianjin Children’s Hospital from January 2020 to December 2021 were divided into control (35 cases) and treatment (35 cases) group by random number table. Children in the control group were iv administered with Meropenem for injection, 20 mg/kg dissolved in 5-10 mL normal saline, 12 h/time for ≤ 7-day-old, 8 h/time for more than 7-day-old. Children in the treatment group were po administered with Combined Bacillus Subtilis and Enterococcus Faecium Granules with Multivitamines, Live on the basis of the control group, 1 bag/time, twice daily. Children in two groups were treated for 7 d. After treatment, the clinical evaluation was evaluated, and the intestinal flora changes, the levels of CD4^＋, CD8^＋, CD4^＋/CD8^＋, and the improvement of clinical symptom in two groups before and after treatment were compared. Results After treatment, the total effective rate in the treatment group was 97.14% compared with 82.86% in the control group (P < 0.05). After treatment, the total number of bacilli, the total number of cocci, the ratio of cocci to bacilli, the ratio of CD4⁺ and CD4⁺/CD8⁺ in two groups were significantly higher than those before treatment (P < 0.05), and which in the treatment group were significantly higher than those in the control group (P < 0.05). After treatment, CD8⁺ in two groups was significantly lower than that before treatment, and which in the treatment group was significantly lower than that in the control group (P < 0.05). The remission time of vomiting, abdominal distension and stool frequency in the treatment group were significantly earlier than those in the control group (P < 0.05). Conclusion Combined Bacillus Subtilis and Enterococcus Faecium Granules with Multivitamines, Live combined with meropenem in treatment of neonatal necrotizing enterocolitis has high efficacy and safety, can accelerate the reproduction and growth of intestinal probiotics and improve the immune function of children.

R975;R985

天津市兒童醫(yī)院發(fā)展基金計(jì)劃項(xiàng)目（Y2020006）