目的 探究孟鲁司特钠联合阿莫西林克拉维酸钾序贯治疗小儿反复下呼吸道感染（RLRTI）的疗效。方法 回顾性选取 2019年 3月—2021年 2月河南医学高等专科学校附属医院收治的 148例 RLRTI患儿，按照治疗方法将其分为对照组和试验组，每组各74例。对照组患儿在常规治疗基础上采用阿莫西林克拉维酸钾序贯疗法，先给予注射用阿莫西林钠克拉维酸钾，每天iv 2次，每次30 mg·kg^-1，每次在3～4 min内缓慢注射，治疗3～5 d，病情稳定后改为口服阿莫西林克拉维酸钾片，每天分2次口服，每次1片，共服用5～9 d，共治疗8～14 d。试验组在对照组的基础上联合孟鲁司特钠颗粒，每晚口服 4 mg，7 d 为 1 个疗程。治疗 2 个疗程。比较两组患儿的临床疗效；检测治疗前后患儿血清免疫功能指标免疫球蛋白 A （IgA）、IgG、IgE、CD4+、CD4⁺/CD8⁺水平；观察两组不良反应发生情况；出院后随访 6个月，观察复发情况。结果 治疗后，试验组治疗总有效率 94.59%，显著高于对照组的 81.08%（P＜0.05）；治疗后两组患儿血清 IgA、IgG、CD4⁺、CD4⁺/CD8⁺水平均显著升高（P＜0.05），且试验组显著高于对照组（P＜0.05）；治疗后两组患儿血清IgE水平均显著降低（P＜0.05），试验组与对照组比较无明显差异（P＞0.05）；治疗期间试验组不良反应总发生率为12.16%，对照组不良反应总发生率为9.46%，两组不良反应总发生率比较，差异无统计学意义（P＞0.05）；患儿出院后随访6个月内，试验组复发率 16.22%，显著低于对照组的 31.08%（P＜0.05）。结论 孟鲁司特钠联合阿莫西林克拉维酸钾序贯疗法能够提高 RLRTI患儿治疗效果，改善患儿免疫功能，有效降低患儿复发率，且安全可靠，值得广泛应用。

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