目的 观察孟鲁司特钠联合盐酸丙卡特罗治疗儿童难治性支原体肺炎的临床效果及对肺功能、血清炎症因子水平的影响。方法 选取2021年6月—2023年5月在合肥市第八人民医院就诊的82例难治性支原体肺炎患儿，随机分为研究组（42例）和对照组（40例），对照组给予常规治疗结合盐酸丙卡特罗（口服，每次1片，每天1次）治疗，研究组在对照组基础上给予孟鲁司特钠（口服，年龄≥6岁者每天1次，每次5 mg，年龄＜6岁者每天1次，每次4 mg）治疗。两组患儿均持续治疗14 d。比较两组患儿治疗效果、病情恢复时间、治疗前后肺功能指标、血清炎症因子水平的差异，记录不良反应发生情况。结果 研究组总有效率（95.24%）显著高于对照组（72.50%，P＜0.05）。研究组住院时间、退热时间、止咳时间、气喘消失时间、啰音消失时间和肺部阴影消失时间均显著低于对照组（P＜0.05）。与治疗前相比，两组患儿治疗14 d后一秒用力呼吸容积（FEV1）、用力肺活量（FVC）、最大呼气中段流量（MMEF）、最大呼气峰流速（PEF）和FEV1/FVC显著升高（P＜0.05）；血清白细胞介素-6 （IL-6）、白细胞介素-13 （IL-13）、白细胞介素-17 （IL-17）、肿瘤坏死因子-α（TNF-α）、γ-干扰素（IFN-γ）、C反应蛋白（CRP）和降钙素原（PCT）水平显著降低（P＜0.05）。且治疗后研究组FEV1、FVC、MMEF、PEF和FEV1/FVC显著高于对照组（P＜0.05）；血清IL-6、IL-13、IL-17、IFN-γ、TNF-α、CRP和PCT水平显著低于对照组（P＜0.05）。两组不良反应发生率差异无统计学意义。结论 孟鲁司特钠联合盐酸丙卡特罗治疗儿童难治性支原体肺炎的效果较好，可有效改善患儿肺功能指标，降低血清炎症因子水平，且安全性较高。

Objective To observe the clinical effect of montelukast sodium combined with propacaterol hydrochloride in the treatment of refractory mycoplasma pneumonia in children and its effect on lung function and serum inflammatory factor level. Methods Eighty-two children who attended the Eighth People's Hospital of Hefei City from June 2021 to May 2023 were selected and randomly divided into a study group (42 cases) and a control group (40 cases). The study group was treated with montelukast sodium (oral, five mg once daily for age ≥ six years and four mg once daily for age < six years) on top of the control group. Both groups were treated for 14 d. The treatment effect, recovery time, lung function indexes and serum inflammatory factor levels before and after treatment were compared, and the occurrence of adverse reactions was recorded. Results The total effective rate of the study group (95.24%) was significantly higher than that of the control group (72.50%, P < 0.05). The study group's hospitalization time, fever reduction time, cough suppression time, asthma disappearance time, rales disappearance time and lung shadow disappearance time were significantly lower than those of the control group (P < 0.05). Compared with the pre-treatment period, the one-second expiratory volume (FEV1), expiratory lung capacity (FVC), maximal mid-expiratory flow (MMEF), maximal peak expiratory flow rate (PEF), and FEV1/FVC were significantly higher in the two study groups after 14 d of treatment (P < 0.05); serum interleukin-6 (IL-6), interleukin-13 (IL-13), interleukin-17 (IL-17), tumor necrosis factor-α (TNF-α), γ-interferon (IFN-γ), Creactive protein (CRP) and procalcitonin (PCT) levels were significantly reduced (P < 0.05). And the FEV1, FVC, MMEF, PEF and FEV1/FVC of the study group were significantly higher than those of the control group after treatment (P < 0.05); serum IL-6, IL-13, IL-17, IFN-γ, TNF-α, CRP and PCT levels were significantly lower than those of the control group (P < 0.05). The difference in the incidence of adverse reactions between the two groups was not statistically significant. Conclusion The effect of montelukast sodium combined with procaterol hydrochloride in the treatment of refractory mycoplasma pneumonia in children is better, which can effectively improve the lung function indexes of the children, reduce the level of serum inflammatory factors, and has higher safety.

R974

合肥市卫生健康委应用医学研究项目（Hwk2020yb0020）