阿奇霉素联合布地奈德混悬液与沙丁胺醇雾化吸入治疗小儿支原体肺炎的效果研究

Study on the effect of azithromycin combined with budesonide suspension and salbutamol aerosol inhalation in treating pediatric mycoplasma pneumonia

目的 探讨阿奇霉素联合布地奈德混悬液+沙丁胺醇雾化吸入治疗小儿支原体肺炎的效果。方法 130例小儿支原体肺炎患儿,采用随机数字表法分为对照组及观察组,各65例。对照组单纯给予阿奇霉素治疗,观察组在对照组基础上联合使用布地奈德混悬液、沙丁胺醇雾化吸入治疗。比较两组患儿的临床疗效,症状与体征消退时间、住院时间,呼吸功能指标[气道阻力(Raw)、肺动态顺应性(Cdyn)、峰值呼气流速(PEF)、第1秒用力呼气容积(FEV1)],炎症因子[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]水平,不良反应发生率。结果 观察组总有效率96.92%明显高于对照组的83.08%,差异具有统计学意义(P<0.05)。观察组患儿的咳嗽、肺部啰音、发热、喘憋消退时间及住院时间分别为(5.33±1.06)、(4.10±0.45)、(3.10±0.28)、(2.41±0.28)、(7.06±0.98)d,相比对照组的(7.82±1.10)、(5.40±0.75)、(7.12±0.52)、(3.56±0.86)、(10.42±1.05)d均明显缩短,差异具有统计学意义(P<0.05)。治疗后,观察组Raw(1.04±0.10)cm H_(2)O/(L·s)(1 cm H_(2)O=0.098 kPa)低于对照组的(1.25±0.22)cm H_(2)O/(L·s), Cdyn(13.32±0.80)ml/cm H_(2)O、PEF(5.62±0.52)L/s、FEV1(3.55±0.40)L高于对照组的(11.06±0.62)ml/cm H_(2)O、(5.08±0.42)L/s、(3.20±0.38)L,差异具有统计学意义(P<0.05)。治疗后,观察组CRP(5.74±0.95)mg/L、TNF-α(8.16±1.32)pg/ml、IL-6(26.28±2.16)pg/ml均低于对照组的(10.08±0.92)mg/L、(14.38±3.05)pg/ml、(51.33±4.25)pg/ml,差异具有统计学意义(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 阿奇霉素联合布地奈德混悬液与沙丁胺醇雾化吸入治疗小儿支原体肺炎患儿药效显著,安全性较高,便于改善炎症状态及呼吸功能,值得临床采纳。

Objective To explore the effect of azithromycin combined with budesonide suspension and salbutamol aerosol inhalation in treating pediatric mycoplasma pneumonia.Methods 130 cases of pediatric mycoplasma pneumonia were divided into a control group and an observation group by random number table method,with 65 cases in each group.The control group was treated with azithromycin alone,and the observation group was treated with budesonide suspension and salbutamol aerosol inhalation on the basis of the control group.Children in both groups were compared in terms of clinical efficacy,time of symptom and sign resolution,length of hospital stay,respiratory function index[airway resistance(Raw),lung dynamic compliance(Cdyn),peak expiratory flow rate(PEF),forced expiratory volume in one second(FEV1)],levels of inflammatory factors[C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)],and the incidence of adverse reactions.Results The total effective rate of 96.92%in the observation group was significantly higher than 83.08%in the control group,and the difference was statistically significant(P<0.05).In the observation group,the time to resolution of cough,pulmonary rale,fever,asthma and the length of hospital stay were(5.33±1.06),(4.10±0.45),(3.10±0.28),(2.41±0.28)and(7.06±0.98)d,which were significantly shorter than(7.82±1.10),(5.40±0.75),(7.12±0.52),(3.56±0.86)and(10.42±1.05)d in the control group.The difference was statistically significant(P<0.05).After treatment,the observation group had lower Raw of(1.04±0.10)cm H2O/(L·s)(1 cm H2O=0.098 kPa)than(1.25±0.22)cm H2O/(L·s)in the control group;the observation group had Cdyn of(13.32±0.80)ml/cm H2O,PEF of(5.62±0.52)L/s,and FEV1 of(3.55±0.40)L,which were higher than(11.06±0.62)ml/cm H2O,(5.08±0.42)L/s,and(3.20±0.38)L in the control group;the difference was statistically significant(P<0.05).After treatment,the observation group had CRP of(5.74±0.95)mg/L,TNF-αof(8.16±1.32)pg/ml,and IL-6 of(26.28±2.16)pg/ml,which were lower than(10.08±0.92)mg/L,(14.38±3.05)pg/ml,and(51.33±4.25)pg/ml in the control group,and 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 Azithromycin combined with budesonide suspension and salbutamol aerosol inhalation have significant efficacy and high safety for the treatment of pediatric mycoplasma pneumonia in children.It is conducive to improving the inflammation state and respiratory function,and is worthy of clinical adoption.