阿奇霉素联合特布他林、脂溶性维生素治疗肺炎支原体感染合并心肌损害患儿的研究

Azithromycin combined with terbutaline and fat-soluble vitamins in the treatment of children with mycoplasma pneumoniae infection and myocardial damage

目的 探究阿奇霉素联合特布他林、脂溶性维生素治疗对肺炎支原体感染合并心肌损害患儿的疗效。方法 选取自2017年1月至2018年1月成都市西区医院收治的100例肺炎支原体感染合并心肌损伤的患儿,按随机数表法分为对照组和观察组,每组各50例。两组患儿入院后均给予常规治疗,在此基础上,对照组患儿再给予阿奇霉素治疗,观察组患儿给予阿奇霉素联合特布他林、脂溶性维生素治疗。比较两组治疗后的一般情况及疗效,检测并分析治疗前后两组患儿心肌酶谱、心肌肌钙蛋白T(cTnT)、炎症因子及外周血红细胞分布宽度(RDW)、E选择素(E-selectin)水平的变化情况。结果 观察组咳嗽消失时间、发热消失时间、肺部啰音消失时间、住院时间及X线检查阴影消失时间均较对照组更短,差异具有统计学意义(P<0.05)。对照组、观察组治疗后总有效率分别为84.00%、98.00%,观察组高于对照组,差异具有统计学意义(P<0.05)。两组患儿治疗前的心肌酶指标天门冬氨酸氨基转移酶(AST)、乳腺脱氢酶(LDH)、肌酶激酶(CK)、肌酸激酶同工酶(CK-MB)及cTnT水平比较,差异均无统计学意义(P>0.05),而治疗后,两组患儿上述指标的水平均出现下降,且以观察组下降更为显著,差异有统计学意义(P<0.05)。两组患儿治疗前的炎症因子超敏-C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)水平比较,差异无统计学意义(P>0.05);而两组患儿治疗后上述炎症因子水平均较治疗前下降,以观察组降低更为显著,差异有统计学意义(P<0.05)。两组患儿治疗前的RDW及E-selectin水平比较差异无统计学意义(P>0.05);与治疗前比较,两组患儿治疗后上述指标均下降,以观察组降低更为显著,差异有统计学意义(P<0.05)。结论 阿奇霉素联合特布他林、脂溶性维生素治疗支原体肺炎合并心肌损害患儿的疗效显著,既能缓解气道炎性反应,又能有效改善并发心肌损伤,降低RDW及外周血E-selectin水平。

Objective To investigate the efficacy of azithromycin combined with terbutaline and fat-soluble vitamins in children with mycoplasma pneumoniae infection and myocardial damage. Methods 100 children with severe pneumonia mycoplasma pneumonia and myocardial injury admitted to Chengdu Western Hospital from January 2017 to January 2018 were enrolled in the study.According to the random number table method,it was divided into control group and observation group,with 50 cases in each group.The two groups of children were given routine treatment after admission.On this basis,the control group was given azithromycin treatment.The patients in the observation group were given azithromycin combined with terbutaline and fat-soluble vitamins.The general condition and efficacy of the two groups after treatment were compared.The changes of myocardial enzymes,cardiac troponin T (cTnT),inflammatory factors and peripheral red blood cell distribution width (RDW) and E-selectin levels were detected and analyzed before and after treatment. Results The disappearance time of cough,fever extinction time,disappearance time of lung rales,hospitalization time and shadow disappearance time in the observation group were shorter than those in the control group,and the differences were statistically significant ( P <0.05).The total effective rates of the control group and the observation group after treatment were 84.00% and 98.00%,respectively.The total effective rate in the observation group was higher than that in the control group ( P <0.05).There was no significant difference in the levels of myocardial enzyme aspartate aminotransferase(AST),lactate dehydrogenase(LDH),creatine kinase(CK),creatine kinase MB(CK-MB),and cTnT before treatment between the two groups ( P >0.05).After treatment,the above-mentioned levels of the two groups of children were decreased( P <0.05).The decrease was more significant in the observation group( P < 0.05 ).There were no significant differences in the levels of high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α) and interleukin-6 (IL-6) before treatment between the two groups ( P >0.05).However,the levels of these inflammatory factors decreased after treatment in both groups ( P <0.05),the decrease was more significant in the observation group ( P < 0.05 ).There were no significant differences in the levels of RDW and E-selectin between the two groups ( P > 0.05 ).Compared with before treatment,the above indexes decreased after treatment ( P <0.05),and the decrease was more significant in the observation group ( P <0.05). Conclusion Azithromycin combined with terbutaline,fat-soluble vitamins in the treatment of mycoplasma pneumoniae with myocardial damage in children has significant effect,can not only relieve airway inflammation,but also effectively improve the myocardial damage,and reduce RDW and peripheral blood E-selectin levels.