低剂量甲基强的松龙对重症肺炎患儿短期预后的影响研究

Effects of low-dose methylprednisolone on short-term prognosis of children with severe pneumonia

目的研究低剂量甲基强的松龙(IVMP)对重症肺炎患儿短期预后的影响。方法选取保定市第二中心医院儿科2018年7月—2021年7月60例重症肺炎患儿为研究对象,通过按照随机数字表法分为观察组与对照组,均30例,观察组低剂量IVMP治疗,给予患儿1~2 mg/(kg·d)的IVMP连续5 d静脉滴注,5 d后改为口服甲泼尼松龙片20 mg/d,7d后逐步停药。对照组采用大剂量IVMP治疗,给予患儿10~20 mg/(kg·d)的IVMP连续3 d静脉滴注,3 d后改为口服甲泼尼松龙片20 mg/d,7 d后逐步停药,两周为一疗程。比较两组临床疗效、临床症状消失时间、治疗前后C-反应蛋白(CRP)、谷丙转氨酶(ALT)、D-二聚体(D-D)、血清白细胞介素6(IL-6)与不良反应发生率。结果两组临床疗效、临床症状消失时间比较差异无统计学意义(P>0.05);两组治疗后与治疗前相比CRP、ALT、D-D、IL-6显著降低,差异有统计学意义(P<0.05)。两组治疗后CRP、ALT、D-D、IL-6差异无统计学意义(P>0.05);观察组不良反应发生率显著低于对照组,比较差异有统计学意义(P<0.05)。结论不同剂量甲基强的松龙治疗重症肺炎患儿均有较好疗效,但低剂量甲基强的松龙临床不良反应较少且较小,有一定临床价值。

Objective To study the effects of low dose methylprednisolone(IVMP)on short-term prognosis of children with severe mycoplasma pneumonia pneumonia(SMPP).Methods A total of 60 children with severe pneumonia in the Department of Pediatrics of Baoding Second Central Hospital from July 2018 to July 2021 were selected as the research objects.They were randomly divided into observation group and control group by word tablemethod,including 30 children in each group.The observation group was treated with low-doseIVMP,andthe children were given 1~2 mg/(kg·d)IVMP intravenous infusion for consecutive 5 days.After 5 days,methylprednisolone tablet was changed to 20 mg orally,and gradually stopped after 7 days.The control group was treated with high-dose IVMP,and the children were given 10~20 mg/(kg·d)IVMP intravenous infusion for 3 days.After 3 days,the children were changed to oral methylprednisolone tablet 20 mg/d.After 7 days,the drug was gradually stopped,two weeks as a course.The clinical efficacy,clinical symptom disappearance time,Creactive protein(CRP),alanine aminotransferase(ALT),D-dimer(D-D),serum interleukin-6(IL-6)and incidence of adverse reactions before and after treatment were compared between the two groups.Results There were no significant differences in clinical efficacy and disappearance time of clinical symptoms between the two groups(all P>0.05).After treatment,the CRP,ALT,D-D and IL-6 levels in the two groups were all significantly lower than those before treatment(all P<0.05).There was no significant difference in CRP,ALT,D-D and IL-6 levels between the two groups after treatment(all P>0.05).The incidence of adverse reactions in the observation group was significantly lower than that in the control group(P<0.05).Conclusion Different doses of methylprednisolone show good curative effect in the treatment of children with SMPP,and the low-dose methylprednisolone treatment causes less clinical adverse reactions and side effects.