阿莫西林克拉维酸钾或头孢他啶联合布地奈德对肺炎患儿的疗效

Effect of Amoxicillin and Clavulanate Potassium or Ceftazidime combined with Budesonide on pneumonia and intestinal microorganisms in children

目的探讨阿莫西林克拉维酸钾或头孢他啶联合布地奈德对肺炎患儿的治疗效果及对肠道微生物的影响。方法选择2016年9月至2018年12月我院儿科收治的90例肺炎患儿为研究对象,入选患儿随机分为对照组(n=45)和研究组(n=45)。另外选取本院同期健康体检的40例儿童为健康组。对照组患儿接受头孢他啶联合布地奈德疗法,研究组患儿采用阿莫西林克拉维酸钾联合布地奈德疗法。连续治疗7 d后,比较两组患儿临床疗效、临床症状(发热、咳嗽、啰音及扁桃体充血)消失时间及不良反应,同时比较各组患儿肠道微生物(乳杆菌、双歧杆菌、真杆菌、肠杆菌及肠球菌)变化情况。结果研究组患儿总有效率为95.56%,对照组总有效率为91.11%,两组比较差异无统计学意义(χ^(2)=0.714,P=0.398)。研究组患儿发热、咳嗽、啰音及扁桃体充血消失时间与对照组比较差异无统计学意义(均P>0.05)。治疗前,研究组和对照组患儿肠道菌群数量与健康组比较差异无统计学意义(均P>0.05)。治疗后,研究组和对照组患儿肠道菌群数量与健康组比较差异有统计学意义(均P<0.05)。治疗后,研究组和对照组患儿肠道乳杆菌、双歧杆菌、真杆菌及肠球菌水平较治疗前显著下降,肠杆菌数量明显上升,差异均有统计学意义(均P<0.05)。治疗后,研究组和对照组患儿肠道菌群数量比较差异无统计学意义(P>0.05)。研究组(8.89%)和对照组(13.33%)总不良反应率比较差异无统计学意义(P>0.05)。结论阿莫西林克拉维酸钾联合布地奈德治疗小儿肺炎疗效显著,能有效缩短患儿临床症状持续时间,其疗效与头孢他啶联合布地奈德疗效相当,且药物副作用较小,但对肠道菌群平衡有破坏作用。因此,扶植肠道菌群可以作为综合治疗的一部分。

Objective To observe the effect of Amoxicillin and Clavulanate Potassium or Ceftazidime combined with Budesonide on pneumonia in children and the effect on intestinal microorganisms.Methods A total of 90 children with pneumonia treated in our hospital from September 2016 to December 2018 were randomly divided into control group(n=45)or observation group(n=45),with 40 healthy children in the same period as the health group.The control group received Ceftazidime combined with Budesonide,while the observation group received Amoxicillin Clavulanate Potassium combined with Budesonide.After 7 days of treatment,the clinical efficacy,time to disappearance of clinical symptoms(fever,cough,rale and tonsil hyperemia),adverse reactions,and changes of intestinal microorganisms(Lactobacillus,Bifidobacterium,Eubacterium,Enterobacter and Enterococcus)were compared among groups.Results The total efficiency rate was 95.56%in the observation group vs 91.11%in the control group,with no significant difference(P>0.05).There was no significant difference in the time to disappearance of fever,cough,rale and tonsil congestion between the observation group and the control group(P>0.05).There were no significant differences in intestinal flora among the 3 groups before treatment(all P>0.05)but among the 3 groups after treatment(all P<0.05).After treatment,the numbers of intestinal Lactobacillus,Bifidobacterium,Eubacterium and Enterococcus in control group and observation group significantly reduced,while that of Enterobacteria significantly increased(all P<0.05).There was no significant difference in the number of intestinal flora between the observation group and control group(P>0.05),neither in the total adverse reaction rate between the observation group(8.89%)and the control group(13.33%).Conclusion Amoxicillin and Clavulanate Potassium combined with Budesonide in the treatment of pediatric pneumonia has a significant effect,which can effectively shorten the idle time of clinical symptoms;the efficacy was similar to Ceftazidime combined with Budesonide,with no toxic side effects but a destructive effect on the intestinal microbial balance.Therefore,intestinal flora can be fostered as part of comprehensive treatment.