目的 探讨乙酰半胱氨酸联合琥乙红霉素治疗儿童重症支原体肺炎的临床疗效。方法 选取2020年1月—2021年12月在唐山市妇幼保健院诊治的106例肺炎患儿，随机分为对照组和治疗组，每组各53例。对照组口服琥乙红霉素颗粒，每次7.5～12.5 mg/kg，4次/d。在对照组的基础上，治疗组雾化吸入吸入用乙酰半胱氨酸溶液，3 mL/次，2次/d。两组用药10 d观察治疗效果。观察两组患者临床疗效，比较治疗前后两组患者症状改善时间，血气指标血氧饱和度（SaO₂）、动脉血氧分压（pO₂）和动脉血二氧化碳分压（pCO₂），白细胞介素-6（IL-6）、降钙素（PCT）、肿瘤坏死因子-α（TNF-α）和γ干扰素（IFN-γ）水平，及不良反应情况。结果 治疗后，治疗组临床有效率为98.11%，明显高于对照组（83.02%，P<0.05）。经治疗，治疗组症状改善时间均早于对照组（P<0.05）。治疗后，两组SaO₂、pO₂指标明显高于治疗前，pCO₂指标明显低于治疗前（P<0.05），且治疗组血气指标水平明显好于对照组（P<0.05）。治疗后，两组IL-6、PCT、TNF-α水平均低于治疗前，而IFN-γ水平高于治疗前（P<0.05），且治疗组明显好于对照组（P<0.05）。治疗后，治疗组不良反应发生率（7.55%）明显低于对照组（13.21%，P<0.05）。结论 琥乙红霉素联合乙酰半胱氨酸雾化吸入治疗效果确切，患儿的症状缓解显著，有效改善血气状态，并能降低机体炎性反应。

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

河北省医学科学研究课题计划（20221763）