阿奇霉素开始治疗时间对肺炎支原体肺炎临床转归的影响

Effects of Initiation Time of Azithromycin on Clinical Outcomes of Mycoplasma Pneumoniae Pneumonia

目的:评价阿奇霉素不同开始治疗时间对肺炎支原体肺炎(MPP)临床转归的影响。方法:选择2016-2017年在我院就诊的MPP患儿335例,按照阿奇霉素开始治疗时间分为早期干预组(发病≤72 h) 109例和晚期干预组(发病>72 h) 226例,均给予阿奇霉素干混悬剂10 mg/(kg·d)晨起顿服,先口服3～5 d,停药3～4 d,再口服3 d,疗程9～12 d,比较两组患儿的临床转归情况及肺外并发症发生率。结果:两组的总病程及严重MPP、肺不张、胸腔积液比例比较差异均无统计学意义(P均>0. 05),而早期干预组肺外并发症发生率为17. 43%,低于晚期干预组的28. 32%(χ2=4. 68,P<0. 05)。治疗后随访结果显示,两组患儿的WBC、CRP、肺不张、胸腔积液复常率比较差异均无统计学意义(P均>0. 05)。结论:阿奇霉素早期使用并不能进一步改善MPP的临床症状及预后,但可以降低肺外并发症的发生率。

Objective: To evaluate the effects of initiation time of azithromycin on clinical outcomes of Mycoplasma pneumoniae pneumonia( MPP). Methods: Totally 355 children with MPP admitted into our hospital from 2016 to 2017 were extracted to be divided into the early intervention group( n = 109)( onset≤72 h) and the advanced intervention group( n = 226)( onset > 72 h) according to initiation time of azithromycin. All patients were given azithromycin dry suspension 10 mg/( kg · d) in the morning,with oral administration for 3 to 5 d,discontinuation of 3 ~ 4 d,and then oral administration for 3 d,the course of treatment was 9 to 12 d. The clinical outcomes and incidence of extra-pulmonary complications were compared between two groups. Results: There was no significant difference between two groups in total course of disease and proportion of severe MPP,atelectasis,pleural effusion( P >0. 05),but the incidence of extra-pulmonary complications in the early intervention group(17. 43%) was lower than of the advanced intervention group(28. 32%),there was significant difference between two groups(χ2= 4. 677,P< 0. 05). The follow-up results after treatment showed that there was no significant difference in the proportion of WBC,CRP,atelectasis,and pleural effusion between two groups( P >0. 05).Conclusion: Early application of azithromycin does not further improve the clinical symptoms and prognosis of MPP,but can reduce the incidence of extrapulmonary complications.