目的 探討乙酰半胱氨酸聯(lián)合琥乙紅霉素治療兒童重癥支原體肺炎的臨床療效。方法 選取2020年1月—2021年12月在唐山市婦幼保健院診治的106例肺炎患兒，隨機分為對照組和治療組，每組各53例。對照組口服琥乙紅霉素顆粒，每次7.5～12.5 mg/kg，4次/d。在對照組的基礎上，治療組霧化吸入吸入用乙酰半胱氨酸溶液，3 mL/次，2次/d。兩組用藥10 d觀察治療效果。觀察兩組患者臨床療效，比較治療前后兩組患者癥狀改善時間，血氣指標血氧飽和度（SaO₂）、動脈血氧分壓（pO₂）和動脈血二氧化碳分壓（pCO₂），白細胞介素-6（IL-6）、降鈣素（PCT）、腫瘤壞死因子-α（TNF-α）和γ干擾素（IFN-γ）水平，及不良反應情況。結果 治療后，治療組臨床有效率為98.11%，明顯高于對照組（83.02%，P<0.05）。經(jīng)治療，治療組癥狀改善時間均早于對照組（P<0.05）。治療后，兩組SaO₂、pO₂指標明顯高于治療前，pCO₂指標明顯低于治療前（P<0.05），且治療組血氣指標水平明顯好于對照組（P<0.05）。治療后，兩組IL-6、PCT、TNF-α水平均低于治療前，而IFN-γ水平高于治療前（P<0.05），且治療組明顯好于對照組（P<0.05）。治療后，治療組不良反應發(fā)生率（7.55%）明顯低于對照組（13.21%，P<0.05）。結論 琥乙紅霉素聯(lián)合乙酰半胱氨酸霧化吸入治療效果確切，患兒的癥狀緩解顯著，有效改善血氣狀態(tài)，并能降低機體炎性反應。

Objective To investigate the clinical efficacy of acetylcysteine and erythromycin ethylsuccinate in treatment of severe mycoplasma pneumonia in children. Methods Children (106 cases) with severe mycoplasma pneumonia in Tangshan Maternal and Child Health Hospital from January 2020 to December 2021 were randomly divided into control and treatment group, and each group had 53 cases. Children in the control group were po administered with Erythromycin Ethylsuccinate Granules, 7.5-12.5 mg/kg, four times daily. Children in the treatment group were atomization inhalation administered with Acetylcysteine Solution for inhalation on the basis of the control group, 3 mL/time, twice daily. Children in two groups were treated for 10 d. After treatment, the clinical evaluation was evaluated, and the improvement of symptom, the blood gas indexes of SaO₂, pCO₂, pO₂, serological level of IL-6, PCT, TNF-α and IFN-γ, and adverse reaction in two groups before and after treatment were compared. Results After treatment, the clinical effective rate of the treatment group was 98.11%, which was significantly higher than that of the control group (83.02%, P< 0.05). After treatment, the improvement time of symptom in the treatment group was earlier than that in the control group (P < 0.05). After treatment, the indexes of SaO₂ and pO₂ in two groups were significantly higher than those before treatment, while the index of pCO₂ was significantly lower than that before treatment (P< 0.05), and the level of blood gas in the treatment group was significantly better than that in the control group (P < 0.05). After treatment, the levels of IL-6, PCT and TNF-α in two groups were lower than those before treatment, while the level of IFN-γ was higher than that before treatment (P < 0.05), and which in the treatment group was significantly better than the control group (P< 0.05). After treatment, the incidence of adverse reactions in the treatment group (7.55%) was significantly lower than that in the control group (13.21%, P < 0.05). Conclusion The therapeutic effect of erythromycin ethyl succinate combined with acetylcysteine is effective, the symptoms of the children are relieved significantly, the blood gas state is effectively improved, and the inflammatory reaction can be reduced.

R974

河北省醫(yī)學科學研究課題計劃（20221763）