β-内酰胺类与大环内酯类抗菌药物联合治疗重症社区获得性肺炎疗效回顾

A study on the efficacy of β-lactam antibiotics combined with macrolides in treatment of severe community-acquired pneumonia in children

目的：探讨β-内酰胺类联合大环内酯类抗菌药物治疗重症儿童社区获得性肺炎（CAP）的临床疗效。方法回顾性分析2012年2月至2012年4月期间住院重症CAP患儿在相同对症支持治疗基础上，采用头孢美唑联合阿奇霉素（研究组）或单用头孢美唑（对照组），在总有效率、体温下降、咳嗽减轻和啰音消失时间以及住院天数方面的差异。结果研究组的总有效率为87.76%，高于对照组（61.22%），两组间差异有统计学意义（χ2=9.08，P=0.003）。研究组体温恢复正常时间、咳嗽消失时间、肺部啰音消失时间以及住院天数分别为（1.82±1.17）d（、6.86±2.06）d（、6.30±2.04）d和（7.28±2.11）d，均短于对照组的（3.25±4.35）d、（9.72±3.96）d、（8.79±4.00）d和（10.14±3.94）d，差异均有统计学意义（Z=3.52-5.53，P均〈0.05）。结论阿奇霉素联合头孢美唑治疗CAP疗效确切，重症CAP患儿联合应用β-内酰胺类与大环内酯类抗菌药物合理且有效。

Objective To investigate the clinical efficacy ofβ-lactam combined with macrolides antibiotics in treatment of severe community-acquired pneumonia （CAP） in children. Methods Children with severe CAP on admission between 2012 February and 2012 April were divided into treatment group and control group. With the same symptom specific supportive treat-ment, the patients in the treatment group were treated with both cefmetazole and azithromycin, while the patients in the control group were treated with cefmetazole alone. The total effective rate, number of days of symptoms and signs disappeared and num-ber of days of hospitalization were observed. Results The total effective rate was 87.8%in the trearment group and 61.3%in the control group with significant difference （P〈0.05）. Compared with control group, the recovery time of temperature, time of pulmonary rale disappearing and cough retraction were reduced （P〈0.05）. As well as the number of days of hospitalization was decreased （P〈0.05）. Conclusions The treatment of severe CAP in children with combination of azithromycin and cefmetazole results in better curative effect. A combined medication ofβ-lactam and macrolides antibiotics may be rational and effective.