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目的探讨甲泼尼龙在儿童难治性肺炎支原体肺炎(RMPP)中的临床应用和疗效。方法 70例RMPP患儿,随机分为对照组和观察组,各35例。两组均采用红霉素抗感染治疗,体温稳定48 h后改阿奇霉素口服序贯治疗,观察组在抗感染的基础上同时使用甲泼尼龙2 mg/(kg·d)静脉滴注治疗。观察两组患儿体温恢复正常时间、咳嗽缓解时间和肺部啰音消失时间,对比治疗前后两组患儿中性粒细胞比值、C反应蛋白和血清铁蛋白改善情况。结果观察组患儿体温恢复正常时间、咳嗽消失时间和肺部啰音消失时间分别为(3.7±1.7)、(5.7±2.1)、(6.6±1.8)d,均短于对照组的(5.8±1.9)、(7.1±2.2)、(7.8±2.1)d,差异具有统计学意义(P<0.05)。治疗后,两组患儿中性粒细胞比值、C反应蛋白、血清铁蛋白等炎症相关指标均较治疗前改善,且观察组患儿改善程度优于对照组,差异具有统计学意义(P<0.05)。结论对于RMPP患儿,在使用大环内酯类抗生素的基础上同时给予甲泼尼龙,能显著缩短症状和体征持续时间,改善炎性指标,加快患儿恢复。
Objective To investigate the clinical application and efficacy of methylprednisolone in children with refractory Mycoplasma pneumoniae pneumonia (RMPP). Methods 70 cases of RMPP children were randomly divided into control group and observation group, 35 cases each. Both groups were treated with erythromycin anti-infective therapy, the treatment group was treated with azithromycin for 48 hours after the temperature was stabilized, and the observation group was treated with 2 mg / (kg · d) methylprednisolone intravenously on the basis of anti-infection. The recovery time of normal temperature, the time of cough relief and the disappearance of pulmonary rales in both groups were observed. The changes of neutrophil ratio, C-reactive protein and serum ferritin in two groups were compared before and after treatment. Results The body temperature recovery time, cough disappearance time and pulmonary rales disappearance time in the observation group were (3.7 ± 1.7), (5.7 ± 2.1) and (6.6 ± 1.8) d respectively, both of which were shorter than those in the control group (5.8 ± 1.9), (7.1 ± 2.2) and (7.8 ± 2.1) d, respectively. The difference was statistically significant (P <0.05). After treatment, the inflammation-related indexes such as neutrophil ratio, C-reactive protein and serum ferritin in both groups were improved compared with before treatment, and the improvement in observation group was better than that in control group (P < 0.05). Conclusions For patients with RMPP, simultaneous administration of methylprednisolone on the basis of macrolide antibiotics can significantly shorten the duration of symptoms and signs, improve the inflammatory markers and accelerate the recovery of children.