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目的探讨地塞米松对儿童社区获得性肺炎(CAP)的疗效。方法选择2010年1月~2012年6月重症CAP患儿120例,随机分为试验组和对照组,试验组62例,对照组58例。2组均给予常规治疗,试验组在常规治疗基础上加用地塞米松,2组疗程均为3 d。比较2组治疗前后各生理学参数及实验室指标、60 d死亡率、住院时间及不良反应。采用SPSS 13.0统计软件对结果进行t检验、非参数秩和检验、χ2检验或Log Rank检验,P≤0.05为差异有统计学意义。结果治疗后2组体温(T)、呼吸频率(RR)、心率(HR)、白细胞(WBC)、中性粒细胞(NEU)及C-反应蛋白(CPR)降低,氧分压(PO2)升高,与治疗前比较差异有统计学意义(P均<0.05);治疗后试验组T、RR、HR、NEU及CPR降低,PO2增加,与对照组比较差异有统计学意义(P均<0.05)。试验组60 d死亡率为11.3%(7/62),对照组15.5%(9/58),差异无统计学意义(P>0.05)。试验组中位数住院时间为13(11,15)d,对照组16(14,18)d,差异有统计学意义(P=0.041)。2组不良反应比较,差异无统计学意义(P>0.05)。结论地塞米松可以减轻重症CAP患儿的症状和全身炎症反应,缩短住院时间,但不能降低死亡率。
Objective To investigate the efficacy of dexamethasone in children with community-acquired pneumonia (CAP). Methods From January 2010 to June 2012, 120 children with severe CAP were randomly divided into experimental group and control group, with 62 cases in trial group and 58 cases in control group. Both groups were given conventional treatment. The experimental group was given dexamethasone on the basis of routine treatment. The two courses of treatment were 3 days. The physiological parameters and laboratory parameters before and after treatment were compared between the two groups. The 60-day mortality, hospital stay and adverse reactions were compared. SPSS 13.0 software was used to analyze the results by t-test, nonparametric rank sum test, χ2 test or Log Rank test. P≤0.05 was considered statistically significant. Results After treatment, the body temperature (T), respiratory rate (RR), heart rate (HR), WBC, NEU and C-reactive protein (P <0.05). After treatment, the levels of T, RR, HR, NEU, CPR and PO2 in the experimental group were significantly lower than those in the control group (all P <0.05), and the difference was statistically significant ). The 60-day mortality rate was 11.3% (7/62) in the experimental group and 15.5% (9/58) in the control group, with no significant difference (P> 0.05). The median length of stay was 13 (11,15) days in the experimental group and 16 (14,18) days in the control group. The difference was statistically significant (P = 0.041). There was no significant difference in adverse reactions between the two groups (P> 0.05). Conclusion Dexamethasone can relieve the symptoms and systemic inflammatory response in children with severe CAP, shorten the hospital stay, but can not reduce the mortality rate.