地塞米松对儿童重症社区获得性肺炎的疗效分析

Effects of dexamethasone on severe community acquired pneumonia in children

目的探讨地塞米松对儿童社区获得性肺炎(CAP)的疗效。方法选择2010年1月~2012年6月重症CAP患儿120例,随机分为试验组和对照组,试验组62例,对照组58例。2组均给予常规治疗,试验组在常规治疗基础上加用地塞米松,2组疗程均为3 d。比较2组治疗前后各生理学参数及实验室指标、60 d死亡率、住院时间及不良反应。采用SPSS 13.0统计软件对结果进行t检验、非参数秩和检验、χ2检验或Log Rank检验,P≤0.05为差异有统计学意义。结果治疗后2组体温(T)、呼吸频率(RR)、心率(HR)、白细胞(WBC)、中性粒细胞(NEU)及C-反应蛋白(CPR)降低,氧分压(PO2)升高,与治疗前比较差异有统计学意义(P均<0.05);治疗后试验组T、RR、HR、NEU及CPR降低,PO2增加,与对照组比较差异有统计学意义(P均<0.05)。试验组60 d死亡率为11.3%(7/62),对照组15.5%(9/58),差异无统计学意义(P>0.05)。试验组中位数住院时间为13(11,15)d,对照组16(14,18)d,差异有统计学意义(P=0.041)。2组不良反应比较,差异无统计学意义(P>0.05)。结论地塞米松可以减轻重症CAP患儿的症状和全身炎症反应,缩短住院时间,但不能降低死亡率。

Objective To investigate the effect of dexamethasone on children with severe community acquired pneumonia(CAP). Methods A total of 120 children with severe CAP were divided randomly into treatment group and control group. Two groups were given conventional treatment, treatment group added dexamethasone. The treatment course was 3 days. Physiological and laboratory parameters before and after treatment were analyzed, mortality with 60 days, length of stay and side effect were compared between two groups. Results Compared with before treatment, after treatment body temperature,respiratory rate, heart rate, WBC, NEU, and C reactive protein(CRP) decreased, whereas PO2increased in both groups(all P<0.05). After treatment, treatment group had lower body temperature, respiratory rate, heart rate, WBC, NEU and CRP, whereas a higher PO2level than control group. Inhospital mortality within 60 days and side effect were not different between two groups(all P>0.05).Median length of hospital stay was significantly shorter in the treatment group compared with in the control group(13 vs. 16 days, P<0.05). Conclusions Dexamethasone can relieve symptoms and attenuate systematic inflammatory response, as well as reduce the length of hospital stay in children with severe CAP. But it can not decrease the mortality in severe CAP children.