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目的探讨红霉素和阿奇霉素抗感染治疗7岁以下儿童支原体肺炎的安全性及临床效果。方法选择2013年1—7月收治的168例儿童支原体肺炎患儿作为研究对象,随机分为对照组和研究组各84例。对照组给予红霉素注射液静脉滴注,根据小儿体重,2~3次/d,22~28 mg/(kg·d),连用7 d后改为口服红霉素,3次/d,25~30 mg/次,连用7 d,每疗程10~14 d。研究组给予阿奇霉素注射液静脉滴注,7.5~10.0 mg/(kg·d),1次/d。分析比较两组患儿临床相关症状改善情况,包括不良反应、退热时间、咳嗽喘憋消失时间、住院天数及肺部湿啰音、哮鸣音消失时间等。治疗1周临床疗效评价及治疗5 d后患儿的肺功能指标及血清生化指标等。计量资料采用t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果研究组住院时间、退热时间、咳嗽喘憋时间、肺部湿啰音及哮鸣音消失时间、肺影像恢复时间分别为(10.02±1.21)、(2.68±1.23)、(10.69±2.12)、(3.68±0.75)、(12.68±3.26)d,均显著低于对照组的(14.51±2.25)、(4.52±2.27)、(13.48±2.97)、(5.37±1.23)、(15.02±4.36)d,差异均有统计学意义(均P<0.05)。对照组不良反应发生率为17.9%,明显高于研究组的1.2%,差异有统计学意义(P<0.05)。研究组总有效率为98.81%,显著高于对照组的46.43%,差异有统计学意义(P<0.05)。治疗5 d后,研究组FVC、FEV1、PEF、AST、ALT、ALP水平分别为(1.15±0.13)、(1.14±0.11)L、(2.92±0.56)L/s、(35.79±1.85)、(33.59±2.75)、(120.39±1.82)IU/L,均显著优于对照组的(1.33±0.46)、(1.21±0.18)L、(2.51±0.31)L/s、(49.85±2.06)、(49.15±2.61)、(153.12±2.46)IU/L,差异均有统计学意义(均P<0.05)。结论阿奇霉素治疗儿童支原体肺炎效果显著优于红霉素,是治疗7岁以下儿童支原体肺炎的安全、有效、服从性良好的药物,康复时间短,不良反应少,有效改善患儿临床症状,缩短住院时间,增强预后,值得临床进一步推广应用。
Objective To investigate the safety and clinical efficacy of erythromycin and azithromycin in the treatment of mycoplasma pneumonia in children under 7 years of age. Methods A total of 168 children with mycoplasma pneumonia admitted in January-July 2013 were selected as study subjects and randomly divided into control group and study group with 84 cases each. The control group was given intravenous infusion of erythromycin injection, according to the body weight of children, 2 ~ 3 times / d, 22 ~ 28 mg / (kg · d), even after 7 d to oral erythromycin, 3 times / 25 ~ 30 mg / time, once every 7 d, each treatment 10 ~ 14 d. The study group given azithromycin injection intravenously, 7.5 ~ 10.0 mg / (kg · d), 1 / d. The clinical symptoms, including adverse reactions, antipyretic time, disappearance time of cough and wheezing, days of hospitalization, wet rales of the lungs, disappearance of wheeze and so on, were analyzed and compared between the two groups. One week clinical efficacy evaluation and treatment of children after 5 days of lung function and serum biochemical indicators. Measurement data using t test, count data using χ2 test, P <0.05 for the difference was statistically significant. Results The length of hospital stay, fever, cough and wheezing time, pulmonary wet rales and wheeze disappearance time and lung imaging recovery time were (10.02 ± 1.21), (2.68 ± 1.23) and (10.69 ± 2.12) , (3.68 ± 0.75) and (12.68 ± 3.26) d in the control group were significantly lower than those in the control group (14.51 ± 2.25, 4.52 ± 2.27, 13.48 ± 2.97, 5.37 ± 1.23, 15.02 ± 4.36, d, the differences were statistically significant (all P <0.05). The incidence of adverse reactions in the control group was 17.9%, which was significantly higher than that of the study group (1.2%) (P <0.05). The total effective rate of the study group was 98.81%, which was significantly higher than that of the control group (46.43%), the difference was statistically significant (P <0.05). The levels of FVC, FEV1, PEF, AST, ALT and ALP in the study group were (1.15 ± 0.13), (1.14 ± 0.11) L, (2.92 ± 0.56) L / s and (35.79 ± 1.85) (1.33 ± 0.46), (1.21 ± 0.18) L, (2.51 ± 0.31) L / s, (49.85 ± 2.06) and (120.39 ± 1.82) IU / L in the control group were significantly higher than those in the control group 49.15 ± 2.61) and (153.12 ± 2.46) IU / L, respectively (all P <0.05). Conclusion Azithromycin is superior to erythromycin in the treatment of mycoplasma pneumonia in children. It is a safe, effective and good compliance drug for treating children with mycoplasmal pneumonia less than 7 years old. The recovery time is short and the adverse reactions are few. It can effectively improve the clinical symptoms and shorten the hospitalization Time, enhance the prognosis, it is worth further clinical application.