不同治疗方案对合并反复呼吸道感染史儿童重症社区获得性肺炎的效果观察

Effects of different treatment regimens on severe community-acquired pneumonia in children with a history of recurrent respiratory infections

目的比较万古霉素、利奈唑胺单用及分别联合脾多肽治疗合并反复呼吸道感染史的重症儿童社区获得性肺炎(CAP)的临床效果。方法选取296例合并反复呼吸道感染史的重症CAP患儿作为研究对象,采用随机数字表法分为万古霉素组(单用万古霉素)、利奈唑胺组(单用利奈唑胺)、联合A组(万古霉素联合脾多肽)、联合B组(利奈唑胺联合脾多肽),每组74例。比较4组患儿的疗效、康复进程(体温恢复正常时间、咳嗽好转时间、呼吸改善时间、住院时间)、不良反应发生情况、直接医疗成本,并通过决策树模型与成效比分析比较各组治疗方案的经济性。结果利奈唑胺组、联合A组、联合B组治疗总有效率分别为83.78%、86.49%、97.30%,均高于万古霉素组的71.62%,且联合B组高于利奈唑胺组、联合A组,差异有统计学意义(P<0.05)。利奈唑胺组、联合A组、联合B组体温恢复正常时间、呼吸改善时间、咳嗽好转时间、住院时间均短于万古霉素组,且联合B组均短于利奈唑胺组、联合A组,差异有统计学意义(P<0.05)。4组患儿不良反应发生情况比较,差异无统计学意义(P>0.05)。4组患儿治疗成本、检查/检验成本、住院成本比较,差异无统计学意义(P>0.05);利奈唑胺组、联合B组、万古霉素组、联合A组药品成本、总成本依次升高,两两比较差异有统计学意义(P<0.05)。成效比从高至低依次为联合A组(75.84)、万古霉素组(73.22)、利奈唑胺组(32.87)、联合B组(32.69),敏感性分析显示该成效比分析结果稳定可靠。结论4种治疗方案中,利奈唑胺联合脾多肽对合并反复呼吸道感染史的重症CAP患儿的疗效最佳,患儿临床获益最明显,且成本-效果优势显著。

Objective To compare the clinical effects of vancomycin,linezolid alone,and their separate combination with spleen polypeptide in the treatment of severe community-acquired pneumonia(CAP)in children with a history of recurrent respiratory infections.Methods A total of 296 children with severe CAP and a history of recurrent respiratory infections were selected as study subjects and randomly divided into four groups:vancomycin group(vancomycin alone),linezolid group(linezolid alone),combined group A(vancomycin combined with spleen polypeptide),and combined group B(linezolid combined with spleen polypeptide),with 74 patients in each group.The curative effects,recovery process(time to normalization of body temperature,time to improvement of cough,time to improvement of respiration,length of hospital stay),adverse reactions,and direct medical costs were compared among the four groups.Decision tree models and cost-effectiveness analysis were used to compare the economics of each treatment plan.Results The total effective rates in the linezolid group,combined group A,and combined group B were 83.78%,86.49%,and 97.30%,respectively,which were all higher than 71.62%in the vancomycin group,and the combined group B had a higher effective rate than the linezolid group and combined group A(P<0.05).The time to normalization of body temperature,improvement of respiration,improvement of cough,and length of hospital stay were shorter in the linezolid group,combined group A,and combined group B than in the vancomycin group,and were shorter in the combined group B compared to the linezolid group and combined group A(P<0.05).There was no statistically significant difference in the occurrence of adverse reactions among the four groups(P>0.05).There were no statistically significant differences in treatment costs,examination/testing costs,and hospitalization costs among the four groups(P>0.05).The treatment costs and total costs were higher in the vancomycin group,combined group A,linezolid group,and combined group B in ascending order,with statistically significant between-group difference(P<0.05).The cost-effectiveness ratios from high to low were combined group A(75.84),vancomycin group(73.22),linezolid group(32.87),and combined group B(32.69).Sensitivity analysis showed that the cost-effectiveness ratio analysis results were stable and reliable.Conclusion Among the four treatment options,the combination of linezolid and spleen polypeptide has the best therapeutic effect in severe CAP children with a history of recurrent respiratory infections,with the most significant clinical benefit and cost-effectiveness advantages.