阿奇霉素序贯疗法治疗中重度肺炎支原体肺炎临床疗效分析

The Efficacy of Sequential Therapy of Azithromycin in Patients with Moderate and Severe Mycoplasma Pneumonia

目的:探讨阿奇霉素序贯疗法治疗中至重度肺炎支原体肺炎的可行性及疗效。方法:选择2008年1月至2010年1月在本院儿科住院诊断为中至重度肺炎支原体肺炎132例。随机分为静脉用药组(甲组)和序贯治疗组(乙组)。甲组用阿奇霉素静脉点滴,10mg/kg.d,每日1次。用5d停3d,再用5d。乙组用阿奇霉素静脉点滴,10mg/kg.d,每日1次,连用3d,第4天改用阿奇霉素(希舒美)口服,10mg/kg.d,连用3d,停4d,再服用5d。观察两组患儿体温、咳嗽,肺部啰音变化和不良反应情况。并于给药第16天复查胸片、抽血查肝功能。结果:甲组治愈60例,乙组治愈44例,两组治愈率比较无统计学意义(X2=0.185 P>0.05)。两组退热时间(3.21±0.72)d vs(3.25±0.767)d,肺部啰音消失时间(6.95±1.63)d vs(6.78±1.94)d。咳嗽明显减轻时间(6.75±1.92)d vs(6.85±1.83)d,胸片阴影消失例数(60例vs 44例)比较均无统计学意义(P>0.05),两组胃肠道反应和皮疹发生率比较均无统计学意义。而肝功能损害(谷丙转氨酶升高)存在明显差异(X2=5.22 P<0.05),局部静脉用药疼痛发生例数比较存在明显差异(X2=10.45 P<0.05)。结论:序贯序法和静脉应用阿奇霉素疗效相同,而肝功能损害,局部静脉疼痛不良反应明显降低。

Objective：To explore the efficacy and feasibility of sequential therapy of azithromycin in patients with moderate and severe mycoplasma pneumonia（MP）.Method：132 cases children with MP diagnosed in our hospital from Jan.2008 to Jan.2010,were divided into first group and second group.The patients in first group were infused 10mg/kg.d azithromycin once a day for 5 days.Then infused again for another 5 days after 3 days drug-withdrawal.The second group were infused 10mg/kg.d azithromycin once a day for 3 days,then took it orally at the fourth day with 10mg/kg.d for 3 days.4 days after drug-with-drawal,took it for another 3 days.Then observed the children’s body temperature,cough pulmonary rale and side effect,Examed the chest X-ray and liver function on the 16th days.Result：60 cases and 44 cases were cured in the first and second group.There’s no significant difference in cure rate between two group（X2=0.185 P〉0.05）,and so were the time of disappearing of cough pulmonary rate,etc.There’s no significant difference in gastrointestinal reaction and the occure rate of rash.While,there’s obviouse differece in the damage of liver function（X2=5.22,P〈0.05）.Conclusion：Comparing with infusion of azithromycin the damage of liver function and the local pain of intravenouse are obviously lower in the second group.