不同剂量甲泼尼龙佐治儿童难治性肺炎支原体肺炎疗效分析
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摘要
目的比较不同剂量的甲泼尼龙在佐治儿童难治性肺炎支原体肺炎(RMPP)的临床疗效,为临床治疗方案提供依据。方法回顾性分析2016年1月至2018年5月许昌中心医院及新乡医学院第一附属医院儿科住院的70例RMPP患儿,依据医治药物的不同分为对照组15例、小剂量治疗组40例、大剂量治疗组15例。对照组选用门冬氨酸阿奇霉素10 mg/kg,静脉滴注,连用5～7 d;小剂量治疗组在对照组治疗基础上,加用甲泼尼龙2 mg/(kg·d),2次/d,静脉滴注5 d;大剂量治疗组在对照组治疗基础上,加用甲泼尼龙30 mg/(kg·d),每天最大剂量为1 g,1次/d,静脉滴注3 d。比较应用不同剂量甲泼尼龙佐治儿童RMPP在治疗前后临床资料方面的差异。结果大、小剂量治疗组的临床总有效、住院时间、热退时间、咳嗽缓解时间及实验室炎性指标改变、影像学改善与对照组比较差异有统计学统计学意义(P <0.05)。大剂量治疗组的热退时间、实验室炎性指标改变、影像学改善及激素不良反应发生情况与小剂量治疗组比较差异有统计学意义(P<0.05)。结论大、小剂量的甲泼尼龙佐治儿童RMPP时,均可提高儿童RMPP的临床总有效率,缩短患儿咳嗽天数,减少住院时间,在缩短患儿发热时间、改善患儿实验室炎性指标、肺部影像学吸收率方面,大剂量较小剂量治疗效果更好。在激素不良反应方面小剂量甲泼尼龙治疗RMPP患儿更具有安全性。
Objective To compare the clinical efficacy of different doses of methylprednisolone in the treatment of Refractory Mycoplasma Pneumoniae Pneumonia(RMPP)in children,and to provide basis for clinical treatment.Methods From January 2016 to May 2018,70 children with RMPP in the Department of Pediatrics of Xuchang Central Hospital and the First Affiliated Hospital of Xinxiang Medical College were retrospectively selected and divided into control group(15 cases),small dose group(40 cases)and large dose group(15 cases). The control group was treated with macrolide drug azithromycin aspartate 10 mg/kg intravenously for 5 to 7 days;the low-dose treatment group was treated with methylprednisolone 2 mg/(kg·d),twice a day,intravenously for 5 days;the high-dose treatment group was treated with methylprednisolone 30 mg/(kg·d)on the basis of the control group,with the maximum dose of 1 g per day,once a day,intravenously for 3 days. To compare the clinical data of RMPP in children treated with different doses of methylprednisolone before and after treatment. Results There were significant differences in total clinical efficacy,hospitalization time,fever regression time,cough relief time,laboratory inflammatory index changes and imaging improvement between the two groups(P<0.05). There were significant differences in fever regression time,laboratory inflammatory index changes,imaging improvement and adverse hormone reactions between high-dose group and low-dose group(P<0.05). Conclusion High and low doses of methylprednisolone can improve the total clinical efficiency of RMPP in children,shorten the cough days and reduce hospitalization time. In terms of shortening fever time,improving laboratory inflammatory index and lung imaging absorption rate,high doses and low doses of methylprednisolone have better therapeutic effect. Low-dose methylprednisolone is safer in the treatment of children with RMPP in terms of adverse hormone reactions.
Objective To compare the clinical efficacy of different doses of methylprednisolone in the treatment of Refractory Mycoplasma Pneumoniae Pneumonia(RMPP)in children,and to provide basis for clinical treatment.Methods From January 2016 to May 2018,70 children with RMPP in the Department of Pediatrics of Xuchang Central Hospital and the First Affiliated Hospital of Xinxiang Medical College were retrospectively selected and divided into control group(15 cases),small dose group(40 cases)and large dose group(15 cases). The control group was treated with macrolide drug azithromycin aspartate 10 mg/kg intravenously for 5 to 7 days;the low-dose treatment group was treated with methylprednisolone 2 mg/(kg·d),twice a day,intravenously for 5 days;the high-dose treatment group was treated with methylprednisolone 30 mg/(kg·d)on the basis of the control group,with the maximum dose of 1 g per day,once a day,intravenously for 3 days. To compare the clinical data of RMPP in children treated with different doses of methylprednisolone before and after treatment. Results There were significant differences in total clinical efficacy,hospitalization time,fever regression time,cough relief time,laboratory inflammatory index changes and imaging improvement between the two groups(P<0.05). There were significant differences in fever regression time,laboratory inflammatory index changes,imaging improvement and adverse hormone reactions between high-dose group and low-dose group(P<0.05). Conclusion High and low doses of methylprednisolone can improve the total clinical efficiency of RMPP in children,shorten the cough days and reduce hospitalization time. In terms of shortening fever time,improving laboratory inflammatory index and lung imaging absorption rate,high doses and low doses of methylprednisolone have better therapeutic effect. Low-dose methylprednisolone is safer in the treatment of children with RMPP in terms of adverse hormone reactions.
引文
[1]范徐威.甲泼尼龙联合阿奇霉素治疗小儿难治性支原体肺炎(RMPP)的疗效与安全性[J].生物医学工程学进展,2015,36(4):246-248.
[2]中华医学会儿科学分会呼吸学组,《中华实用儿科临床杂志》编辑委员会.儿童肺炎支原体肺炎诊治专家共识(2015年版)[J].中华儿科杂志,2015,30(17):1304-1307.
[3]郑明纲.短疗程糖皮质激素辅助治疗小儿难治性肺炎支原体肺炎的疗效分析[J].中外医疗,2017,36(35):132-135.
[4]宋宪蓉,杜宇哲.糖皮质激素在儿童难治性肺炎支原体肺炎中的研究[J].中国药物与临床,2017,17(6):888-890.
[5]冯孝强,高春燕.小儿难治性肺炎支原体肺炎免疫机制及治疗研究进展[J].临床合理用药杂志,2016,9(13):174-176.
[6]荣杰鑫,王亚亭,李远波,等.甲泼尼龙对儿童难治性肺炎支原体肺炎疗效和安全性评价的Meta分析[J].安徽医药,2017,21(9):1688-1693.
[2]中华医学会儿科学分会呼吸学组,《中华实用儿科临床杂志》编辑委员会.儿童肺炎支原体肺炎诊治专家共识(2015年版)[J].中华儿科杂志,2015,30(17):1304-1307.
[3]郑明纲.短疗程糖皮质激素辅助治疗小儿难治性肺炎支原体肺炎的疗效分析[J].中外医疗,2017,36(35):132-135.
[4]宋宪蓉,杜宇哲.糖皮质激素在儿童难治性肺炎支原体肺炎中的研究[J].中国药物与临床,2017,17(6):888-890.
[5]冯孝强,高春燕.小儿难治性肺炎支原体肺炎免疫机制及治疗研究进展[J].临床合理用药杂志,2016,9(13):174-176.
[6]荣杰鑫,王亚亭,李远波,等.甲泼尼龙对儿童难治性肺炎支原体肺炎疗效和安全性评价的Meta分析[J].安徽医药,2017,21(9):1688-1693.