清肺通络方治疗儿童耐大环内酯类肺炎支原体肺炎的临床观察

Clinical Observation of Qingfei Tongluo Decoction in the Treatment of Children with Macrolide Resistant Mycoplasma Pneumoniae Pneumonia

目的观察清肺通络方治疗儿童耐大环内酯类肺炎支原体肺炎(痰热闭肺证)的疗效及安全性。方法将80患儿随机分为治疗组与对照组各40例。对照组予阿奇霉素静滴7d,停药4d后继续口服阿奇霉素3d,疗程共14d;治疗组静滴阿奇霉素7d,从治疗第1天起予清肺通络方口服替代治疗,疗程共14d。所有患儿根据具体情况,必要时可考虑使用甲强龙及布洛芬。观察两组临床疗效、中医证候积分、C反应蛋白(CRP)、降钙素原(PCT)、乳酸脱氢酶(LDH)、支原体抗体Ig M(MP-Ig M)、影像学改变等指标。结果治疗组总有效率为77.50%,高于对照组的65.00%(P<0.05)。治疗后,两组中医证候总积分、主要证候积分、次要证候积分均较治疗前改善(P<0.05),且治疗组改善均优于对照组(P<0.05)。热退时间、咳嗽消失时间、啰音消失时间及激素使用天数比较,治疗组短于对照组(P<0.05)。治疗后,两组CRP、LDH及PCT均较治疗前改善(P<0.05),治疗组CRP改善优于对照组,差异有统计学意义(P<0.05);治疗组治疗后LDH、PCT水平与对照组相当(P>0.05)。治疗后,两组肺部影像学均较治疗前好转(P<0.05)。治疗前后两组均未出现三大常规、肝肾功能安全性指标异常。结论运用清肺通络方替代阿奇霉素序贯治疗儿童耐大环内酯类肺炎支原体肺炎(痰热闭肺证)的临床疗效优于单用阿奇霉素,可缩短患儿病程,减轻炎性反应,安全性良好,无不良反应。

Objective:To observe the efficacy and safety of Qingfei Tongluo Decoction in the treatment of Macrolide Resistant Mycoplasma Pneumoniae Pneumonia(MRMP)(phlegm heat obstructing lung syndrome) in children.Methods:A total of 80 children who were diagnosed with MRMP(phlegm heat and heat closed lung syndrome) were randomly divided into two groups.The control group was given azithromycin for 7 days with intravenous drip,and azithromycin was given for 3 days with oral administration after 4 days of stopping.The treatment group stopped the drug after 7 days of intravenous administration of azithromycin,and then took Qingfei Tongluo Decoction as an oral alternative treatment from the first day of treatment,and the treatment course was 14 days.All children may consider using methylpredolone and ibuprofen if necessary.Results:The therapeutic effect of the disease was different between the two groups(P <0.05),and the treatment group was better than the control group.After treatment,the total score,main syndrome score and secondary syndrome score of two groups were improved compared with those before treatment(P <0.05),the improvement of the above syndrome of the treatment group was better than that of the control group after treatment,the difference was statistically significant(P<0.05).After treatment,CRP,LDH and PCT of the two groups were improved compared with those before treatment,and the difference was statistically significant(P <0.05).LDH and PCT were improved,and the treatment group was similar to the control group,and the difference was not statistically significant(P> 0.05).After treatment,the imaging of lung in both groups was better than before,and the difference was statistically significant(P <0.05),the difference between the treatment group and the control group was similar(P> 0.05).Before and after treatment,there were no three abnormal indexes of routine and safety of liver and kidney function.Conclusion:The clinical effect of using Qingfei Tongluo Decoction instead of azithromycin in sequential treatment of MRMP(phlegm heat obstructing lung syndrome) is better than that of azithromycin alone.It can shorten the course of the children,reduce the inflammatory response,and have good safety and good response,which is worth further promotion.