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目的探讨孟鲁司特钠和硫酸沙丁胺醇缓释胶囊治疗小儿肺炎支原体肺炎(mycoplasma pneumoniae,MPP)气道高反应的成本及效果。方法以2007年10月至2008年10月374例支气管肺炎患儿为观察对象,确诊为肺炎支原体感染185例(抗体滴度≥1:160或双份血清试验4倍以上升高),将其中合并气道高反应的118例患儿纳入本研究,并分为常规治疗(A组)、常规治疗+硫酸沙丁胺醇缓释胶囊(B组)及常规治疗+孟鲁司特钠(C组),统计各组患儿刺激性咳嗽的发生率、治疗后刺激性咳嗽持续时间、缓解时间及住院天数,测定呼吸峰流速值;以上海市二级甲等医院的收费标准进行成本-效果分析。结果肺炎支原体肺炎患儿气道高反应的发生率为63.8%;与常规治疗组相比,应用硫酸沙丁胺醇缓释胶囊与孟鲁司特钠均可缩短患儿刺激性咳嗽的病程;成本-效果分析提示硫酸沙丁胺醇缓释胶囊组的成本效果优于孟鲁司特钠组,成本-效果比为0.86(P<0.05)。结论考虑临床疗效和医疗费用,硫酸沙丁胺醇缓释胶囊治疗无其他合并症的MPP患儿较孟鲁司特钠有更好的成本-效果,值得临床借鉴。
Objective To investigate the cost and effectiveness of montelukast sodium and salbutamol sulfate sustained-release capsules in the treatment of airway hyperresponsiveness in children with mycoplasma pneumoniae (MPP). Methods From October 2007 to October 2008, 374 cases of children with bronchial pneumonia were selected as the observation subjects, and 185 cases were confirmed as Mycoplasma pneumoniae infection (antibody titer≥1: 160 or double serum test more than 4 times) A total of 118 children with acute airway hyperresponsiveness were enrolled in this study and were divided into two groups: conventional treatment (group A), conventional therapy plus salbutamol sulfate sustained-release capsules (group B) and conventional therapy plus montelukast sodium (group C) The incidence of irritating cough, duration of irritating cough, length of stay and number of days of hospitalization after treatment were calculated. The peak-to-peak respiratory flow rate was calculated. The cost-effectiveness analysis was carried out in Shanghai Grade A First Class Hospital. Results The incidence of airway hyperresponsiveness in children with Mycoplasma pneumoniae pneumonia was 63.8%. Compared with the conventional treatment group, salbutamol sulfate sustained-release capsules and montelukast sodium could shorten the course of irritating cough in children. Cost-effectiveness The analysis suggested that the cost-effectiveness of salbutamol sulfate sustained-release capsules group was better than that of montelukast sodium group, with a cost-effect ratio of 0.86 (P <0.05). Conclusion Considering the clinical efficacy and medical costs, salbutamol sulfate sustained-release capsules have a better cost-effectiveness than montelukast for the treatment of MPP in children without other comorbidities, which deserves clinical reference.