余德钊　徐嘉辉　韦泓娟　蓝燕娇　李宏贵　林晓洁

摘要：目的 观察中药外治法联合大桑菊合剂口服治疗儿童肺炎支原体肺炎的临床疗效。方法 将100例肺炎支原体肺炎患儿随机分为治疗组和对照组各50例。对照组口服阿奇霉素并予常规对症治疗，7 d为1个疗程，连续治疗3个疗程；治疗组在对照组治疗基础上，口服大桑菊合剂并予中药外治封包局部热敷（肺俞、膻中）治疗，阿奇霉素使用2个疗程后停药，其余治疗均连续进行3个疗程。观察2组患儿症状缓解和肺部体征消失所需时间，评价2组的治疗效果，并于治疗前后（第1、21日）检验肺炎支原体抗体（MP-IgM）血清浓度。结果 治疗组患儿发热、咳嗽、肺部体征改善时间均优于对照组（P<0.05）。治疗组总有效率为96.0%（48/50），对照组为74.0%（37/50），组间比较差异有统计学意义（P<0.05）。治疗组患儿治疗前后血清MP-IgM浓度转阴率（82%）明显优于对照组（58%），差异有统计学意义（P<0.05）。结论 中药外治法联合大桑菊合剂口服能够明显改善肺炎支原体肺炎患儿的临床症状与体征，缩短病程，疗效显著；同时能够缩短阿奇霉素的疗程，减少不良反应，为儿童抗生素药物管理提供参考。

关键词：中药外治法；大桑菊合剂；肺炎支原体肺炎

DOI：10.3969/j.issn.1005-5304.2016.03.007

中图分类号：R272.956.31 文献标识码：A 文章编号：1005-5304（2016）03-0023-04

Abstract： Objective To investigate the clinical efficacy of TCM external treatment combined with Dasangju Mixture in treating mycoplasma pneumoniae pneumonia （MPP） in children. Methods One hundred patients with MPP were randomly divided into control group and treatment group by parallel design， with 50 patients in each group. Patients in control group orally took azithromycin combined with other symptomatic treatment when necessary， 7 d for a course and continuously for 3 courses. Based on the treatment for control group， patients in treatment group were added with TCM external treatment （BL13 and RN17） combined with Dasangju Mixture， while azithromycin was sequentially used just for 2 courses. Other types of treatment lasted for 3 courses. The improvement time of symptoms and signs of the patients were recorded and the therapeutic effects of the two groups were evaluated. Moreover， the serum concentrations of mycoplasma pneumoniae-immune gloulin M （MP-IgM） were determined before and after treatment on the 1st and 21st days. Results The improvent time of fever， and cough and lung sign of the treatment group were more obviously shortened than the control group （P<0.05）. The total effective rate was 96.0% （48/50） in observation group and 74.0% （37/50） in control group， with statistical significant difference between the two groups （P<0.05）. After treatment， the negative rate of the serum concentration of MP-IgM in the treatment group was 82%， and that of the control group was 58%， with statistical significance between the two groups （P<0.05）.

肺炎支原体（MP）是儿童社区获得性肺炎重要病原体之一。流行病学研究表明，肺炎支原体肺炎（MPP）发病率逐年上升，且在1～3岁婴幼儿中有增多趋势[1]。儿童MPP的临床表现以发热、咳嗽，部分患儿有喘鸣，肺部可出现啰音为特征。由于MP缺乏青霉素结合蛋白，故对β内酰胺类抗感染药物天然拮抗，加之四环素类、喹诺酮类和氨基糖苷类药物不宜甚至禁止用于儿童，大环内酯类抗生素成为治疗MPP的首选药物，核因子-κB抑制剂阿奇霉素是目前推荐常规治疗MPP的药物[2]。大桑菊合剂是本课题组的临床验方和广东省第二中医院院内制剂，前期研究表明其具有抗炎抑菌作用[3]，能够明显减少MP，疗效确切[4]。……