抗生素降阶梯治疗小儿重症肺炎的效果研究

Study on Effect of Antibiotics De-escalation Therapy in Pediatric Severe Pneumonia

目的:研究抗生素降阶梯法治疗小儿重症肺炎的效果。方法:选取2020年1月—2022年1月武穴市第一人民医院儿科收治的64例重症肺炎患儿作为研究对象,根据随机数字表法分为两组,各32例。对照组采用常规抗生素治疗,观察组采用抗生素降阶梯治疗。比较两组治疗效果、炎性因子水平、免疫指标水平、各项临床指标及不良反应发生情况。结果:观察组治疗总有效率高于对照组,差异有统计学意义(P=0.010)。治疗前,两组CD8^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平比较,差异无统计学意义(P>0.05);治疗后,观察组CD4^(+)、CD4^(+)/CD8^(+)水平高于对照组,CD8^(+)水平低于对照组,差异有统计学意义(P<0.001)。治疗前,两组白细胞介素-8(IL-8)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平比较,差异无统计学意义(P>0.05);治疗后,观察组IL-8、IL-6、TNF-α水平均低于对照组,差异有统计学意义(P<0.001)。观察组使用抗生素、呼吸困难改善、咳嗽改善、体温恢复及啰音消失时间均短于对照组,差异有统计学意义(P<0.001)。观察组不良反应发生率低于对照组,差异有统计学意义(P=0.023)。结论:抗生素降阶梯法治疗小儿重症肺炎的效果显著,可改善患儿临床症状、免疫功能及炎性因子水平,缩短抗生素使用时间,降低不良反应发生率。

Objective:To investigate the effect of antibiotics de-escalation therapy in children with severe pneumonia.Methods:A total of 64 children with severe pneumonia admitted to Department of Pediatrics,Wuxue No.1 People's Hospital from January 2020 to January 2022 were selected as the study subjects.According to the random number table method,the patients were divided into two groups,with 32 cases in each group.The control group was treated with conventional antibiotics,and the observation group was treated with antibiotics de-escalation therapy.The treatment effect,inflammatory factor levels,immune index levels,clinical indicators and occurrence of adverse reactions in the two groups were compared.Results:The total effective rate of treatment in the observation group was higher than that in the control group,and the difference was statistically significant(P=0.010).Before treatment,there was no significant difference in the levels of CD8^(+),CD4^(+),CD4^(+)/CD8^(+)between the two groups(P>0.05).After treatment,the CD4^(+)and CD4^(+)/CD8^(+)levels in the observation group were higher than those in the control group,and the CD8^(+)levels in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.001).Before treatment,there was no significant difference in the levels of interleukin-8(IL-8),interleukin-6(IL-6),and tumor necrosis factor-α(TNF-α)between the two groups(P>0.05).After treatment,the levels of IL-8,IL-6 and TNF-αin the observation group were lower than those in the control group,and the differences were statistically significant(P<0.001).The time of using antibiotics,dyspnea improvement,cough improvement,body temperature recover,and rale disappearance in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.001)..The incidence of adverse reactions in the observation group was lower than that in the control group,and the difference was statistically significant(P=0.023).Conclusion:The antibiotics de-escalation therapy has significant effects in treating the children with severe pneumonia,it can improve clinical symptoms,immune function and inflammatory factor levels,shorten the time of using antibiotics,and reduce the incidence of adverse reactions.