大剂量氨溴索与阿奇霉素联合治疗对儿童肺炎支原体肺炎疗效及血清淀粉样蛋白A(SAA)水平的影响研究

Study on efficacy of high-dose ambroxol combined with azithromycin on children with mycoplasma pneumoniae pneumonia and its influence on serum amyloid A level

目的观察不同剂量氨溴索联合阿奇霉素治疗儿童肺炎支原体肺炎的效果,以期保障患儿整体获益水平。方法120例肺炎支原体肺炎患儿,采用随机数字表法分为对照组和观察组,每组60例。对照组采取常规剂量盐酸氨溴索注射液联合阿奇霉素颗粒治疗,观察组采取大剂量盐酸氨溴索注射液联合阿奇霉素颗粒治疗。比较两组治疗效果、不良反应发生情况及治疗前、治疗结束时肺功能指标[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、最大呼气流速(PEF)]、血气分析指标[动脉血氧分压(PaO_(2))与动脉血二氧化碳分压(PaCO_(2))]、血清淀粉样蛋白A(SAA)水平。结果观察组治疗总有效率98.33%高于对照组的86.67%,差异有统计学意义(P<0.05)。治疗结束时,对照组FEV1、FVC、PEF分别为(1.08±0.49)L、(1.39±0.59)L、(1.81±0.60)L/s,观察组分别为(1.66±0.56)L、(1.81±0.62)L、(2.42±0.72)L/s。治疗结束时,两组FEV1、FVC、PEF均较本组治疗前升高,且观察组升高幅度高于对照组,差异有统计学意义(P<0.05)。治疗结束时,对照组PaO_(2)、PaCO_(2)、SAA水平分别为(64.02±5.85)mm Hg(1 mm Hg=0.133 kPa)、(55.65±4.15)mm Hg、(9.35±2.15)mg/L,观察组分别为(76.12±6.52)mm Hg、(41.85±3.65)mm Hg、(7.05±1.85)mg/L。治疗结束时,两组PaO_(2)较本组治疗前升高,PaCO_(2)、SAA水平较本组治疗前下降,且观察组PaO_(2)升高幅度及PaCO_(2)、SAA水平下降幅度均高于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论大剂量氨溴索联合阿奇霉素可显著提高儿童肺炎支原体肺炎患儿的治疗效果,有利于改善患儿血气分析指标、SAA水平,提高肺功能,且安全可靠,建议在临床相关治疗中推荐开展。

Objective To observe the effect of high-dose ambroxol combined with azithromycin in the treatment of mycoplasma pneumoniae pneumonia in children,in order to ensure the overall benefit level of children.Methods 120 children with mycoplasma pneumoniae pneumonia were divided into a control group and an observation group by random number table method,with 60 cases in each group.The control group was treated with conventional dose of ambroxol hydrochloride injection and azithromycin granules,and the observation group was treated with high-dose ambroxol hydrochloride injection and azithromycin granules.Both groups were compared in terms of the treatment effect,the occurrence of adverse reactions and the lung function indicators[forced vital capacity(FVC),forced expiratory volume in one second(FEV1),peak expiratory flow rate(PEF)]at the end of treatment,blood gas analysis index[arterial partial pressure of oxygen(PaO_(2))and arterial partial pressure of carbon dioxide(PaCO_(2))],and serum amyloid A(SAA)level.Results The total effective rate of the observation group was 98.33%,which was higher than 86.67%of the control group,and the difference was statistically significant(P<0.05).At the end of treatment,FEV1,FVC and PEF in the control group were(1.08±0.49)L,(1.39±0.59)L and(1.81±0.60)L/s,and those in the observation group were(1.66±0.56)L,(1.81±0.62)L and(2.42±0.72)L/s.At the end of treatment,FEV1,FVC and PEF in both groups were higher than those before treatment,and the increase amplitude in the observation group was higher than that in the control group;the difference was statistically significant(P<0.05).At the end of treatment,the levels of PaO_(2),PaCO_(2)and SAA in the control group were(64.02±5.85)mm Hg(1 mm Hg=0.133 kPa),(55.65±4.15)mm Hg and(9.35±2.15)mg/L,and those in the observation group were(76.12±6.52)mm Hg,(41.85±3.65)mm Hg and(7.05±1.85)mg/L.At the end of treatment,PaO2 in both groups was higher than that before treatment,PaCO2 and SAA levels were lower than those before treatment;the increase amplitude of PaO_(2) and the decrease amplitude of PaCO_(2) and SAA levels in the observation group were higher than those in the control group;the difference was statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion High-dose ambroxol combined with azithromycin can significantly improve the therapeutic effect of children with mycoplasma pneumoniae pneumonia,help to improve blood gas analysis indexes,SAA levels,and improve lung function in children.It is safe and reliable,and is recommended to be promoted in clinical treatment.