古奕文等

[摘要] 目的 探讨阿奇霉素序贯疗法治疗小儿支原体肺炎的临床效果。 方法 选取本院2012年2月～2014年3月收治的支原体肺炎患儿215例，将其随机分为观察组（107例）和对照组（108例），对照组采用红霉素序贯疗法治疗，观察组采用阿奇霉素序贯疗法。比较两组的临床疗效及不良反应情况。 结果 观察组总有效率为94.4%，高于对照组的75.9%，差异有统计学意义（χ2=14.468，P<0.01）。观察组退热、咳嗽消失、啰音消失、呕吐消失时间及住院时间均明显短于对照组，差异有统计学意义（P<0.05）。观察组恶心、呕吐、泄泻等胃肠道反应，皮疹，ALT升高的发生率明显低于对照组，差异有统计学意义（P<0.05）。 结论 阿奇霉素序贯疗法治疗小儿支原体肺炎效果显著，可缩短治疗时间，减少不良反应的发生，效果优于红霉素，可成为治疗小儿支原体肺炎的首选疗法，具有临床推广意义。

[关键词] 阿奇霉素；序贯疗法；小儿支原体肺炎；效果；不良反应

[中图分类号] R974 [文献标识码] A [文章编号] 1674-4721（2015）02（a）-0066-03

Effect of azithromycin sequential therapy in the treatment of children with Mycoplasma pneumonia

GU Yi-wen ZHANG Yu-hua MA Yuan-ping

Department of Child medicine，People′s Hospital of Meizhou City in Guangdong Province，Meizhou 514000，China

[Abstract] Objective To explore the efficacy of azithromycin sequential therapy in the treatment of children with Mycoplasma pneumonia. Methods 215 children with Mycoplasma pneumonia treated in our hospital from February 2012 to March 2014 were selected，and were randomly divided into observation group （107 cases） and control group （108 cases），control group were given with erythromycin sequential therapy，observation group were treated with azithromycin sequential therapy.The clinical efficacy and adverse reactions of two groups was compared. Results The t otal effective rate of observation group was 94.4%，higher than 75.9% of control group，the difference was significant （χ2=14.468，P<0.01）. The time of fever，cough disappeared，rales disappeared，vomiting disappeared and length of stay hospital in observation group was shorter than that in control group，the difference was significant （P<0.05）.The incidence of gastrointestinal reaction，including nausea，vomiting，diarrhea etc.，rash and ALT increasing in observation group was lower than that in control group，the difference was significant （P<0.05）. Conclusion The curative effect of azithromycin sequential therapy is significant，can shorten the treatment time，reduce the adverse reactions，its efficacy is better than erythromycin，therefore become the preferred therapy in treatment of Mycoplasma pneumonia in children，has clinical promotion.

[Key words] Azithromycin；Sequential therapy；Mycoplasma pneumonia；Efficacy；Adverse reaction

肺炎支原体（Mycoplasma pneumoniae）是一种感染支原体肺炎的病原体，具有很强的传染性，儿童对其免疫力很低，在小儿呼吸道感染的病原体中所占比例>30%。肺炎支原体所引起的急性呼吸道感染并伴有肺炎被称之为支原体肺炎[1]。小儿支原体肺炎多发于<3岁的婴幼儿，其感染率近几年不断升高，全年均可感染，临床表现主要为发热、咳嗽、呼吸困难以及肺部湿性啰音等，病情严重者可能出现器官衰竭甚至死亡[2-3]。第一代大环内酯类抗生素红霉素是临床上应用较多的治疗药物，对支原体肺炎的疗效较好，但后来研究发现，随着用药时间的延长，红霉素具有较大的不良反应，甚至对肝肾等器官也具有一定的毒害[4]。后来研究发现，阿奇霉素也是一种大环内酯类的抗生素，具有与红霉素类似的药效，但其具有吸收好、渗透性高、耐酸及生物利用度高等优点，逐渐取代红霉素。本研究探讨阿奇霉素序贯疗法对小儿支原体肺炎的治疗效果及不良反应。……