目的 探究新生儿坏死性小肠结肠炎接受肠腹壁造口术后，对感染指标和免疫指标的影响效果，以及术中、术后不良反应发生情况。方法 选取2016年1月—2024年1月因坏死性小肠结肠炎在潍坊市妇幼保健院接受肠腹壁造口术的56例患儿为A组，另收集同时期因坏死性小肠结肠炎行I期肠切除肠吻合的39例患儿为B组，观察并比较两组患儿术前、术后免疫指标和感染指标的变化情况。另收集同时期40名健康新生儿，对比A组患儿出院前的免疫、感染指标的与健康新生儿差异情况。出院后继续门诊随访，观察术后并发症及不良反应发生情况。结果 A组和B组患儿接受手术后，免疫指标（IgA、IgG、IgM）较术前呈上升趋势，而感染指标（IL-6、PCT、TNF-α）较术前下降。出院前1天A组IgG、IgM水平均高于B组，差异有统计学意义（t=2.312，P=0.023；t=3.214，P=0.002）。B组患儿术后第2天、术后第7天、出院前1天IL-6水平高于A组，差异有统计学意义（t=-4.252，P＜0.001；t=-3.383，P=0.001；t=-2.505，P=0.014）。至出院前1天，A组患儿的免疫指标和感染指标与健康新生儿相比，差异无统计学意义（P＜0.05）。所有手术患儿住院期间至还纳手术前无严重并发症发生。结论 肠腹壁造口术对患有坏死性小肠结肠炎的患儿治疗效果较好，可在一定程度上减轻炎症反应，改善患儿免疫功能。远期效果较好，安全性良好。
Objective To investigate the effect of enterostomy on infection indexes and immune indexes in necrotizing enterocolitis，as well as the occurrence of enterostomy and postoperative adverse reactions．Methods Fifty-six neonates who underwent enterostomy for necrotizing enterocolitis in Weifang Maternal and Child Health Hospital from January 2016 to January 2024 were selected as Group A，and 39 neonates who underwent phase I intestinal resection and anastomosis for necrotizing enterocolitis during the same period were selected as Group B．The changes of preoperative and postoperative immune indicators and infection indicators between the two groups of neonates were observed and compared．In addition，40 healthy neonates were selected during the same period，and the differences in immune and infection indexes between group A and healthy neonates were compared before discharge．Patients were followed up after discharge to observe postoperative complications and adverse reactions．Results After surgery，the immune indexes（IgA，IgG，IgM）of the two groups（A and B） were higher than those before surgery，while the infection indexes（IL-6，PCT，TNF-α）were significantly lower than those before surgery．The levels of IgG and IgM in Group A were higher than those in Group B one day before discharge，and the differences were statistically significant（t=2.312，P=0.023；t=3.214，P=0.002）．In Group B，the levels of IL-6 on postoperative day two，postoperative day seven，and one day before discharge were significantly higher than in Group A．The differences were statistically significant（t=-4.252，P＜0.001；t=-3.383，P=0.001；t=-2.505，P=0.014）．By one day before discharge，the immune indicators and infection indicators of the infants in Group A were not significantly different from those of healthy newborns．No serious complications occurred among all surgical patients during their hospital stay until the enterostomy closure．Conclusions Enterostomy has a good therapeutic effect on neonates with necrotizing enterocolitis，which can reduce the inflammatory response and improve the immune function of children to a certain exten，with better long-term effects and good safety．
目的 探讨透明质酸钠注射联合富含血小板的血浆治疗膝骨关节炎患者的效果。方法 收集2019年7月—2021年7月在本院就诊的膝骨关节炎患者120例,采用随机数字表法分组,即对照组、观察组,均60例。对照组患者注入富含血小板的血浆(4 mL),观察组患者注射透明质酸钠(2 mL)联合富含血小板的血浆(3.5 mL),1次/周,3次为1个疗程,共2～3疗程。统计2组患者膝关节功能、临床疗效及并发症发生率。结果 ①组内比较:治疗后2月、3月及6月平均Lysholm膝关节评分均升高,P<0.05;②组间比较:治疗前及治疗后2月,2组患者平均Lysholm膝关节评分比较,P>0.05,治疗后3月、6月,2组平均Lysholm膝关节评分比较,P<0.05。2组患者Lysholm膝关节评分均较治疗前有所改善,P<0.05;观察组疼痛评分(18.92±4.11、17.61±3.83)分、肿胀度评分(10.64±2.82、9.66±1.21)分均高于对照组疼痛评分(14.02±3.52、13.54±3.21)分、肿胀度评分(9.62±2.63、8.71±1.93)分(P<0.05)。观察组临床总有效率98.33%高于对照组临床总有效率88.33%(χ2=4.821,P=0.028)。经过6个月的随访后,2组均1例出现局部肿胀,未发生其他并发症。结论 透明质酸钠注射联合富含血小板的血浆治疗膝骨关节炎患者,可以有效改善患者膝关节功能,减轻患者疼痛及肿胀程度等,安全性高,值得推广应用。
Objective To investigate the effect of sodium hyaluronate injection combined with platelet-rich plasma in the treatment of patients with knee osteoarthritis. Methods A total of 120 patients with knee osteoarthritis who were treated in our hospital from July 2019 to July 2021 were collected and randomly divided into control group and observation group,60 cases each.The patients in the control group were injected with platelet-rich plasma(4 mL),and the patients in the observation group were injected with sodium hyaluronate(2 mL)combined with platelet-rich plasma(3.5 mL),once a week,3 times as a course of treatment,total 2-3 courses of treatment.The knee joint function,clinical efficacy and complication rates of the two groups were compared. Results ①Intra-group comparison:the average Lysholm knee joint scores were significantly increased in 2 months,3 months and 6 months after treatment,P<0.05. ②Comparison between groups:before and 2 months after treatment,the average Lysholm knee joint scores of the two groups were significantly increased (P<0.05). After 3 months and 6 months treatment,the comparison of the average Lysholm knee score between the two groups were statistic significant (P<0.05).The Lysholm knee joint scores in both groups were improved compared with those before treatment (P<0.05). Three months after treatment,the pain score(18.92±4.11, 17.61±3.83)and swelling score(10.64±2.82, 9.66±1.21)in the observation group were significantly higher than those in the control group(14.02±3.52, 13.54±3.21, 9.62±2.63, 8.71±1.93, P<0.05).The total clinical effective rate of the observation group was 98.33%,which was significantly higher than that of the control group (88.33%, χ2=4.821,P=0.028).After 6-month follow-up,local swelling occurred in 1 case in both groups,and no other complications occurred. Conclusions Sodium hyaluronate injection combined with platelet-rich plasma in the treatment of patients with knee osteoarthritis can effectively improve the knee joint function and reduce the pain and swelling of the patients.It is safe and worthy of popularization and application.
