小剂量注射用甲泼尼龙琥珀酸钠冲击治疗对儿童难治性支原体肺炎的效果

Eflect of Small Doses of Methylprednisolone Treatment of Children with Refractory Mycoplasma

目的探讨小剂量注射用甲泼尼龙琥珀酸钠冲击治疗对儿童难治性支原体肺炎的效果。方法选择2013年1月至2015年3月收治的儿童难治性支原体肺炎患儿58例,依据随机数字表法分为对照组和试验组,各29例。对照组患儿在常规治疗基础上给予阿奇霉素静脉滴注10 mg/kg,每日1次,第2~5日为5 mg/kg,每日1次,5 d为1个总疗程;试验组患儿在此基础上连续静脉滴注注射用甲泼尼龙琥珀酸钠1.5~2.0 mg/(kg·d),每日1次,静脉滴注治疗3 d后改为1 mg/kg,每日1次,1周内递减剂量至停药。观察比较两组临床症状体征缓解情况、试验室结果及影像学改善情况。结果试验组患儿退热时间、咳嗽消失时间、肺部啰音消失时间显著短于对照组[(8.3±3.1)d比(13.2±2.8)d,(7.8±2.5)d比(11.9±2.9)d,(12.6±2.6)d比(17.2±2.6)d](P<0.05)。试验组患儿治疗后白细胞、中性粒细胞、C反应蛋白显著低于对照组[(3.2±1.6)×10~9/L比(4.3±2.2)×10~9/L,0.52±0.09比0.61±0.08,(9.5±2.2)ng/L比(17.3±3.1)ng/L](P<0.05)。试验组患儿治疗后肺部纹理、门影增大、斑片状影、膜病变比例显著低于对照组[10.3%(3/29)比34.5%(10/29),6.9%(2/29)比27.6%(8/29),6.9%(2/29)比27.6%(8/29),6.9%(2/29)比31.0%(9/29)](P<0.05)。结论小剂量注射用甲泼尼龙琥珀酸钠联合抗生素治疗儿童难治性支原体肺炎具有显著疗效,可以显著改善患儿的病情,缩短病程,改善患儿预后,值得临床推广。

Objective To analyze the effect of small doses of methylprednisolone in treatment of children with refractory mycoplasma pneumonia. Methods From Jan. 2013 to Mar. 2015,58 children with intractable childhood pneumonia in Beijing Huairou Hospital were included in the study,according to the random number method they were divided into a control group and a test group,29 cases each. The control group received intravenous azithromycin on the basis of conventional therapy,10 mg / kg on the 1st day,5 mg / kg from the 2nd to 5th day,5 days as a total treatment course; the test group was added with methylprednisoloneon on the basis of the control group,1. 5-2. 0 mg /（ kg·d）,1 time / day intravenously for 3 days then changed to 1 mg / kg,1 time / day,decreasing the dose till end within 1 week. The relief of clinical symptoms and signs,laboratory results and imaging improvement of the two groups were compared. Results The fever clearance time,cough disappearance time,pulmonary rales disappearance time of the test group was significantly shorter than those of the control group[（ 8. 3 ± 3. 1） d vs（ 13. 2 ± 2. 8） d,（ 7. 8 ± 2. 5） d vs（ 11. 9 ± 2. 9） d,（ 12. 6 ± 2. 6） d vs（ 17. 2 ± 2. 6） d]（ P〈0. 05）.After treatment the white blood cells,neutrophils,C-reactive protein of the test group were significantly lower than those of the control group [（ 3. 2 ± 1. 6） × 10~9/ L vs（ 4. 3 ± 2. 2） × 10~9/ L,0. 52 ± 0. 09 vs 0. 61 ± 0. 08,（ 9. 5 ± 2. 2） ng / L vs（ 17. 3 ± 3. 1） ng/L]（ P〈0. 05）. AThe proportions of lung texture,portal shadow enlargement,patchy shadow and membrane lesions of the test group were significantly lower than those of the control group[10. 3%（ 3 /29） vs 34. 5%（ 10 /29）,6. 9%（ 2 /29） vs 27. 6%（ 8 /29）,6. 9%（ 2 /29） vs 27. 6%（ 8 /29）,6. 9%（ 2 /29） vs 31. 0%（ 9 /29） ]（ P〈0. 05）.Conclusion Small doses of methylprednisolone and antibiotic treatment of children with refractory mycoplasma pneumonia has a significant effect,which can significantly improve the condition of children,shorten the disease course and improve the prognosis,thus is worthy of promotion in clinical.