高压氧辅助治疗对儿童急性耐甲氧西林金黄色葡萄球菌性骨髓炎疗效的影响

Effectiveness of hyperbaric oxygen adjuvant therapy for acute methicillin-resistant staphylococcal osteomyelitis in children

目的探讨高压氧辅助治疗儿童急性耐甲氧西林金黄色葡萄球菌性骨髓炎的疗效及对炎症指标水平的影响。方法选择2016年1月至2019年12月郑州大学第一附属医院小儿外科收治的符合纳入标准的急性耐甲氧西林金黄色葡萄球菌性骨髓炎患儿56例,按治疗方法分为观察组和对照组,每组28例。对照组采用常规负压封闭引流术联合静脉抗生素治疗,观察组在对照组的基础上辅以高压氧治疗。比较两组治疗后临床疗效及炎症指标[C反应蛋白(CRP)、白细胞计数(WBC)、红细胞沉降率(ESR)]水平的变化。组间比较计数资料采用χ^(2)检验,计量资料采用两独立样本t检验。结果观察组患儿总治愈率高于对照组(89.29%比64.28%,χ^(2)=4.909,P<0.05),差异有统计学意义;观察组治疗1周、治疗2周、治疗3周后的CRP水平低于对照组[(46.55±12.16)mg/L比(54.39±15.62)mg/L,(12.89±5.53)mg/L比(16.17±4.86)mg/L,(3.04±2.12)mg/L比(4.32±2.28)mg/L,t=2.096、2.358、2.176,P值均<0.05],差异有统计学意义;观察组治疗2周、治疗3周后的WBC水平低于对照组[(7.21±3.51)×10^(9)/L比(9.93±2.19)×10^(9)/L、(6.05±1.67)×10^(9)/L比(7.92±1.44)×10^(9)/L,(t=3.479、4.487,P值均<0.01),差异有统计学意义;观察组治疗3周的ESR水平低于对照组[(18.32±6.15)mm/h比(21.86±5.78)mm/h,(t=2.219,P<0.05),差异有统计学意义。结论高压氧辅助负压封闭引流术能明显提高急性耐甲氧西林金黄色葡萄球菌性骨髓炎患儿的治愈率,并显著降低炎症指标的水平。

Objective To investigate the efficacy of hyperbaric oxygen in the treatment of acute methicillin-resistant staphylococcal osteomyelitis in children and its effect on inflammatory markers.Methods Totally 56 children with acute methicillin-resistant staphylococcal osteomyelitis treated in the Department of Pediatric Surgery of the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2019 were divided into observation group and control group(n=28 each).The control group was treated with conventional negative pressure closed drainage combined with intravenous antibiotics,and the observationl group was treated with hyperbaric oxygen on the basis of the control group.The clinical efficacy and the changes of inflammatory markers[C-reactive protein(CRP),white blood cell count(WBC),erythrocyte sedimentation rate(ESR)]were compared between the two groups after treatment.The counting data were analyzed using the chi-square test and the measurement data were analyzed using independent samples t test for comparisons of two groups.Results The cure rate of the observation group(89.29%)was significantly higher than that of the control group(64.28%)(χ^(2)=4.909,P<0.05).The level of CRP[(46.55±12.16),(12.89±5.53),(3.04±2.12)mg/L]at 1st,2nd,and 3rd week after treatment in the observation group was lower than in the control group[(54.39±15.62),(16.17±4.86),(4.32±2.28)mg/L,t=2.096,2.358,2.176,P<0.05,0.05,0.05].The WBC[(7.21±3.51)×10^(9)/L,(6.05±1.67)×10^(9)/L]at 2nd and 3rd week after treatment in the observation group was less than in the control group[(9.93±2.19)×10^(9)/L,(7.92±1.44)×10^(9)/L,t=3.479,4.487,P<0.01,0.01].The ESR[(18.32±6.15)mm/h]at 3rd week after treatment in the observation group was lower than that in the control group[(21.86±5.78)mm/h,t=2.219,P<0.05].Conclusion Hyperbaric oxygen-assisted negative pressure closed drainage can significantly improve the cure rate of methicillin-resistant Staphylococcus Aureus osteomyelitis and significantly reduce the level of inflammatory markers.