目的 探究孟魯司特鈉聯(lián)合阿莫西林克拉維酸鉀序貫治療小兒反復(fù)下呼吸道感染（RLRTI）的療效。方法 回顧性選取 2019年 3月—2021年 2月河南醫(yī)學(xué)高等?？茖W(xué)校附屬醫(yī)院收治的 148例 RLRTI患兒，按照治療方法將其分為對照組和試驗(yàn)組，每組各74例。對照組患兒在常規(guī)治療基礎(chǔ)上采用阿莫西林克拉維酸鉀序貫療法，先給予注射用阿莫西林鈉克拉維酸鉀，每天iv 2次，每次30 mg·kg^-1，每次在3～4 min內(nèi)緩慢注射，治療3～5 d，病情穩(wěn)定后改為口服阿莫西林克拉維酸鉀片，每天分2次口服，每次1片，共服用5～9 d，共治療8～14 d。試驗(yàn)組在對照組的基礎(chǔ)上聯(lián)合孟魯司特鈉顆粒，每晚口服 4 mg，7 d 為 1 個(gè)療程。治療 2 個(gè)療程。比較兩組患兒的臨床療效；檢測治療前后患兒血清免疫功能指標(biāo)免疫球蛋白 A （IgA）、IgG、IgE、CD4+、CD4⁺/CD8⁺水平；觀察兩組不良反應(yīng)發(fā)生情況；出院后隨訪 6個(gè)月，觀察復(fù)發(fā)情況。結(jié)果 治療后，試驗(yàn)組治療總有效率 94.59%，顯著高于對照組的 81.08%（P＜0.05）；治療后兩組患兒血清 IgA、IgG、CD4⁺、CD4⁺/CD8⁺水平均顯著升高（P＜0.05），且試驗(yàn)組顯著高于對照組（P＜0.05）；治療后兩組患兒血清IgE水平均顯著降低（P＜0.05），試驗(yàn)組與對照組比較無明顯差異（P＞0.05）；治療期間試驗(yàn)組不良反應(yīng)總發(fā)生率為12.16%，對照組不良反應(yīng)總發(fā)生率為9.46%，兩組不良反應(yīng)總發(fā)生率比較，差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）；患兒出院后隨訪6個(gè)月內(nèi)，試驗(yàn)組復(fù)發(fā)率 16.22%，顯著低于對照組的 31.08%（P＜0.05）。結(jié)論 孟魯司特鈉聯(lián)合阿莫西林克拉維酸鉀序貫療法能夠提高 RLRTI患兒治療效果，改善患兒免疫功能，有效降低患兒復(fù)發(fā)率，且安全可靠，值得廣泛應(yīng)用。

Objective To investigate the efficacy of montelukast sodium combined with amoxicillin-clavulanate potassium sequential therapy on children with recurrent lower respiratory tract infection (RLRTI). Methods A total of 148 children with RLRTI who were admitted to the Affiliated Hospital of Henan Medical College from March 2019 to February 2021 were retrospectively selected and divided into control group and experimental group according to the treatment methods, with 74 cases in each group. The children in the control group were treated with amoxicillin-clavulanate potassium sequential therapy on the basis of conventional treatment. First, they were given Amoxicillin Sodium-Clavulanate Potassium for injection twice a day, 30 mg·kg^-1 for each time. Each time, they were slowly injected within three to four minutes, and treated for three to five days. After the condition was stable, they were changed to oral Amoxicillin-Clavulanate Potassium Tablets, which were taken twice a day, one tablet each time, five to nine days in total, and eight to 14 days in total. The experimental group was combined with Montelukast Sodium Granules on the basis of the control group, taking 4 mg orally every night for seven days as a course of treatment. Two courses of treatment. The clinical efficacy of the two groups was compared. The levels of serum immunoglobulin A (IgA), IgG, IgE, CD4⁺, CD4⁺/CD8⁺were measured before and after treatment. The adverse reactions of the two groups were observed. Follow up for six months after discharge to observe the recurrence. Results After treatment, the total effective rate of the experimental group was 94.59%, which was significantly higher than that of the control group (81.08%, P＜0.05). After treatment, the levels of serum IgA, IgG, CD4⁺ , CD4⁺/CD8⁺ in the two groups were significantly higher than those of before treatment (P＜0.05), and there was significant difference between experimental group and control group (P＜0.05). After treatment, the serum IgE level of the two groups were significantly reduced (P＜0.05), and there was no significant difference between the experimental group and the control group (P＞0.05). During the treatment, the total incidence of adverse reactions in the experimental group was 12.16%, while that in the control group was 9.46%. There was no significant difference between the two groups (P＞0.05). The recurrence rate in the experimental group was 16.22%, significantly lower than that in the control group (31.08%, P＜0.05). Conclusion Montelukast sodium combined with amoxicillin-clavulanate potassium sequential therapy can improve the therapeutic effect of children with RLRTI, improve the immune function of children, effectively reduce the recurrence rate of children, and is safe and reliable, which is worth extensive application.

R985