目的 探讨枯草杆菌二联活菌颗粒联合美罗培南治疗新生儿坏死性小肠结肠炎的有效性和安全性。方法 选取2020年1月—2021年12月天津市儿童医院收治的70例新生儿坏死性小肠结肠炎患儿，采用随机数字表法将其分为对照组（35例）和治疗组（35例）。对照组静脉滴注注射用美罗培南，20 mg/kg溶解于5～10 mL生理盐水中，日龄≤7 d患儿12 h/次，日龄＞7 d患儿8 h/次。治疗组在对照组基础上口服枯草杆菌二联活菌颗粒，1袋/次，2次/d。两组患儿治疗7 d。观察两组患儿临床疗效，比较治疗前后两组患儿肠道菌群变化，CD4^＋、CD8^＋、CD4^＋/CD8^＋值及临床症状改善情况。结果 治疗后，治疗组患儿总有效率97.14%较对照组的82.86%显著增加（P＜0.05）。治疗后，两组患儿杆菌总数、球菌总数、球杆菌比值及CD4^＋、CD4^＋/ CD8^＋值均显著高于治疗前（P＜0.05），且治疗组患儿明显高于对照组（P＜0.05）。治疗后，两组患儿CD8^＋显著低于治疗前（P＜0.05），且治疗组患儿明显低于对照组（P＜0.05）。治疗组患儿呕吐缓解时间、腹胀缓解时间及大便次数性状复常时间均明显早于对照组（P＜0.05）。结论 枯草杆菌二联活菌颗粒联合美罗培南治疗新生儿坏死性小肠结肠炎具有较高疗效和安全性，可加速患儿肠道益生菌繁殖生长，改善患儿免疫功能。

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

天津市儿童医院发展基金计划项目（Y2020006）