小儿推拿辅助治疗儿童难治性肺炎支原体肺炎临床观察

Clinical observation of pediatric Tuina as an auxiliary therapy for refractory mycoplasma pneumoniae pneumonia in children

目的探讨小儿推拿辅助治疗儿童难治性肺炎支原体肺炎(RMPP)的疗效和安全性。方法选取自2023年1月至2024年1月收治的73例RMPP患儿为研究对象。采用随机数字表法将患儿分为联合治疗组(n=36)和阿奇霉素治疗组(n=37)。所有患儿均接受阿奇霉素抗感染治疗和辅助治疗;联合治疗组在此基础上施以清热、益肺、止咳手法的小儿推拿。比较两组患儿中医证候评分、主要症状、体征消退时间、实验室化验指标、治疗有效率、不良反应等。结果与治疗前比较,两组患儿治疗后中医证候总积分、主证积分和次证积分均显著降低,差异有统计学意义(P<0.05);治疗后,联合治疗组总积分、主证积分和次证积分均低于阿奇霉素治疗组,差异有统计学意义(P<0.05)。与治疗前比较,两组患儿治疗后白细胞计数(WBC)、C反应蛋白(CRP)、乳酸脱氢酶(LDH)、纤维蛋白原(FIB)和D-二聚体(D-D)均显著降低,差异有统计学意义(P<0.05)。治疗后,联合治疗组血小板(PLT)计数低于治疗前,差异有统计学意义(P<0.05)。治疗后,联合治疗组患儿PLT计数、CRP、LDH、FIB和D-D均低于阿奇霉素治疗组,差异有统计学意义(P<0.05)。联合治疗组咳嗽消失时间、高热消退时间及肺部啰音消失时间均短于阿奇霉素治疗组,差异有统计学意义(P<0.05)。治疗14 d,两组患儿的治疗总有效率均达100.0%,阿奇霉素治疗组的愈显率为78.4%(29/37),明显低于联合治疗组的94.4%(34/36),差异有统计学意义(P<0.05)。治疗期间,两组患儿均未发生严重不良反应。阿奇霉素治疗组患儿恶心呕吐、腹痛腹泻和皮疹的发生率分别为37.8%(14/37)、27.0%(10/37)和35.1%(13/37),均高于联合治疗组的16.7%(6/36)、8.3%(3/36)和11.1%(4/36),差异有统计学意义(P<0.05)。结论小儿推拿对儿童RMPP治疗具有辅助作用,不良反应少。

Objective To evaluate the effectiveness and safety of pediatric Tuina as an auxiliary therapy for refractory mycoplasma pneumoniae pneumonia(RMPP)in children.Methods A total of 73 patients with RMPP admitted from January 2023 to January 2024 were selected as the study subjects.According to the random number table method,they were divided into two groups,combination treatment group(n=36)and azithromycin treatment group(n=37).All patients received azithromycin treatment and adjuvant therapy.On this basis,the combination treatment group was administered Tuina therapy aimed at clearing heat,benefiting the lungs,and relieving cough.Some parameters such as the traditional Chinese medicine syndrome scores,time for major symptoms to subside,laboratory-test indicators,treatment efficacy,adverse reactions were compared between two groups.Results The total score of traditional Chinese medicine syndrome,main syndrome score,and secondary syndrome score of the two groups after treatment were significantly reduced than the scores of the two groups before treatment,and the differences were statistically significant(P<0.05).After treatment,the total score,main symptom score,and secondary symptom score of the combination treatment group were all lower than those of the azithromycin treatment group,and the differences were statistically significant(P<0.05).The levels of white blood cell count(WBC),C-reactive protein(CRP),lactate dehydrogenase(LDH),fibrinogen(FIB),and D-dimer(D-D)of the two groups after treatment were significantly reduced than those of the two groups before treatment,and the differences were statistically significant(P<0.05).After treatment,the platelet count(PLT)in the combination treatment group was lower than that before treatment,and the difference was statistically significant(P<0.05).After treatment,the PLT count,CRP,LDH,FIB,and D-D in the combined treatment group were lower than those in the azithromycin treatment group,and the differences were statistically significant(P<0.05).The time of cough disappearance,fever resolution and lung rale disappearance in the combination treatment group were shorter than those in the azithromycin treatment group,and the differences were statistically significant(P<0.05).After 14 days of treatment,the total effective rates of treatment of the two groups both reached 100.0%.The effect and recovery rate of azithromycin treatment group was 78.4%(29/37),which was significantly lower than that of combined treatment group[94.4%(34/36)],and the difference was statistically significant(P<0.05).During the treatment period,no serious adverse reactions were observed in the both groups.The incidence rates of nausea and vomiting,abdominal pain and diarrhea,and rash in the azithromycin treatment group were 37.8%(14/37),27.0%(10/37)and 35.1%(13/37),respectively,which were higher than those in the combined treatment group[16.7%(6/36)],[8.3%(3/36)]and[11.1%(4/36)],the difference was statistically significant(P<0.05).Conclusion Pediatric Tuina has an auxiliary therapeutic effect on children RMPP,with fewer adverse reactions.