新生儿RSV肺炎的临床症状及干扰素治疗效果观察

Clinical symptoms of neonates with RSV pneumonia and therapeutic effect of interferon

目的研究重组人干扰素α1b对新生儿呼吸道合胞病毒(RSV)肺炎临床症状及肺部功能恢复的影响。方法选取2012年1月至2017年1月在秦皇岛市第二医院儿科就诊的150例新生儿RSV肺炎患儿为阳性组,另随机抽取150例同期出生RSV检查阴性的新生儿为阴性组。将阳性组中所有患儿随机分为观察组和对照组,每组各75例患者。入院后,对照组患者进行常规治疗,观察组在常规治疗的基础上增加使用重组人干扰素α1b。对比阳性组和阴性组的肺部啰音消失时间、住院时间、吸氧天数,于一周后评估两组临床疗效。测定并比较观察组和对照组两组患儿的肺功能指标。结果阳性组与阴性组呛奶和发热的发生率比较,差异均无统计学意义(χ~2值分别为0.277、0.905,均P>0.05);阳性组患儿咳嗽、鼻塞、细湿啰音、哮鸣音的发生率明显高于阴性组(χ~2值分别为30.767、27.540、85.394、11.777,均P<0.05);阳性组患儿纯母乳喂养率明显低于阴性组(χ~2=6.595,P<0.05)。观察组的啰音消失时间、吸氧天数和住院时间明显少于对照组(t值分别为-2.306、-3.643、-2.985,均P<0.05),观察组患者的治疗有效率(85.33%)明显高于对照组患者(62.67%)(χ~2=10.014,P<0.05)。治疗期间,观察组和对照组患者均未出现出血、皮疹、心率异常等严重不良反应。治疗后,观察组和对照组的呼吸比(IT/ET)、呼气峰流速(PEF)、达峰容积(VPEF)、吸气时间(IT)、呼气时间(ET)水平比较,差异均无统计学意义(t值分别为-0.855、-1.003、-1.535、-0.272、-0.699,均P>0.05);观察组患儿的MV、TV、TPTEF/TE、VPEF/VE和TPTEF水平均高于对照组,RR值明显低于对照组,差异均有统计学意义(t值分别为2.310、2.048、2.007、2.559、2.403、-2.034,均P<0.05)。结论鼻塞、咳嗽、哮鸣音、细湿鸣音、纯母乳喂养率低为新生儿RSV肺炎的主要临床特征,使用干扰素治疗新生儿RSV肺炎有显著疗效,能有效促进肺部功能的恢复。

Objective To investigate the effect of recombinant human interferon α1b on the clinical symptoms and pulmonary function recovery of respiratory syncytial virus（RSV）pneumonia in neonates.Methods One hundred and fifty neonates with RSV pneumonia visiting pediatrics department of the Second Hospital of Qinhuangdao from January 2012 to January 2017 were selected as positive group,and 150 neonates undergoing physical check at the same period and detected as RSV negative were randomly selected as negative group.All patients in the positive group were randomly divided into observation group and control group with 75 patients in each group.After admission,patients in the control group received routine treatment,while patients in the observation group received recombinant human interferon α1b on basis of routine treatment.Disappear time of pulmonary rales,time of hospitalization and days of oxygen inhalation in positive group and negative group were observed and compared,and clinical efficacy in two groups was evaluated after one week.Pulmonary function indexes in the observation group and the control group were measured and compared.Results There were no significant differences in incidences of choking and fever between positive group and negative group（χ~2 value was 0.277 and 0.905,respectively,both P〈0.05）.Incidences of cough,nasal obstruction,fine moist rales and wheezing in positive group were significantly higher than those in negative group（χ~2 value was 30.767,27.540,85.394 and 11.777,respectively,all P〈0.05）.Rate of pure breast feeding in positive group was lower than that in negative group（χ~2=6.595,P〈0.05）.Time of rales disappearance,days of oxygen inhalation and length of hospital stay in the observation group were significantly less than those in the control group（t value was -2.306,-3.643 and -2.985,respectively,all P〈0.05）.Treatment effective rate in the observation group was 85.33%,which was significantly higher than that of 62.67%in the control group（χ~2=10.014,P〈0.05）.During treatment,patients in two groups did not appear bleeding,rash,heart rate abnormalities and other serious adverse reactions.After treatment,IT/ET,peak expiratory flow（PEF）,volume to peak expiratory flow（VPEF）,inspiratory time（IT）,expiratory time（ET）had no significant differences between the observation group and the control group（t value was -0.855,-1.003,-1.535,-0.272 and-0.699,respectively,all P〈0.05）.After treatment,levels of MV,TV,TPTEF/TE,VPEF/VE and TPTEF in the observation group were higher than those in the control group,and RR value was significantly lower with significant differences（t value was 2.310,2.048,2.007,2.559,2.403 and -2.034,respectively,all P〈0.05）.Conclusion Nasal obstruction,cough,wheeze,fine moist rales,low breastfeeding rate are main clinical features of neonatal RSV pneumonia.Interferon has significant curative effect in treatment of neonatal RSV pneumonia,and can effectively promote the recovery of lung function.