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[摘要] 目的:评价头孢呋辛或头孢呋辛脂序贯治疗儿童支气管肺炎的可行性、疗效及安全性,并进行治疗成本分析。方法:选择静脉头孢呋辛治疗有效的98例支气管肺炎患儿,随机分为序贯治疗组和对照组。序贯治疗组病情稳定后转为头孢呋辛脂口服治疗;对照组继续静滴头孢呋辛,两组均用药至症状体征基本消失。比较两组疗效差异并进行治疗成本分析。结果:序贯治疗组和对照组痊愈率分别为81.6%、83.6%,有效率分别为93.9%、95.9%,两组治愈率和有效率相比,差异均无统计学意义(P>0.05),两组均无明显不良反应发生。序贯治疗组抗生素费用及医疗总费用治疗显著低于对照组。结论:头孢呋辛序贯治疗儿童支气管肺炎不但安全、有效,而且更加经济合理。
[关键词] 序贯治疗;头孢呋辛;儿童;支气管肺炎
[中图分类号] R725.7 [文献标识码]A [文章编号]1674-4721(2010)03(a)-029-02
Analysis of efficacy and economic evaluation of sequential therapy with cefuroxime for children with bronchopneumonia
PENG Yueming1,LIANG Mo2*,LIU Bin1
(1.Maternal and Child Health Hospital of Changde, Changde 415000, China; 2.Hunan People′s Hospital, Changsha 410005, China)
[Abstract] Objective: To evaluate the effect and cost of sequential therapy with cefuroxime in children with bronchipneimonia. Methods: 98 cases of children with bronchipneimonia whose pathogenetic condition had been partly controlled by 3 days treatment with intravenous drop infusion with cefuroxime divided into the SAT group (by sequential therapy) and control group(by persistent intravenous drop infusion with cefuroxime) randomly. The recovery rates, overall efficacy rates and medical costs of the two groups were evaluated. Results: The recovery rates of SAT group and control group were 81.6% and 83.6% respectively(P>0.05), and their overall efficacy rates were 93.9% and 95.9% respectively(P>0.05). Except the hospital day, there was no significant difference in the clinical effect between SAT group and control group. And no adverse effect were found in the two groups. But the total expenses and antibiotic cost of the medical treatment of SAT group was oviously lower than those of control group. Conclusion: Sequential therapy with cefuroxime for children with bronchopneumonia is not only safe,valid,but more economic reasonable.
[Key words] Sequential therapy; Cefuroxime; Children; Bronchipneimonia
肺炎是威胁我国儿童健康的严重疾病,占住院儿童总人数的24.5%～56.2%,而发展中国家小儿肺炎以细菌病原为主,因此,抗生素疗法成为治疗儿童肺炎的重要措施[1]。目前临床使用的抗生素品种繁多,随着经济的发展和医疗经费控制的加强,如何合理选择抗生素,制定安全、有效、经济的治疗方案,以减少医疗资源的浪费已成亟待解决的问题。本研究选择头孢呋辛序贯治疗儿童支气管肺炎取得良好效果,现报道如下:
1 资料与方法
1.1 一般资料
2007年3月～2009年11月在本院儿科病房住院的支气管肺炎患儿154例。支气管肺炎诊断标准为[1]:有发热、咳嗽,肺部听诊闻及固定性中、细湿性�音或胸片见斑片状阴影,同时具备外周血WBC>10×109/L,中性粒细胞比例增高,CRP>15 mg/L,临床上考虑为细菌性肺炎。剔除标准:①对头孢呋辛或头孢羟氨苄过敏者;②有重症肺炎表现者;③伴有严重的心脏病、低血钾、血液系统、中枢系统疾病严重疾病者者;④已明确有支原体、衣原体或军团菌近期感染者;⑤48 h内用过其他抗生素者;⑥年龄在6个月以下或近期反复住院者。所有患者均给予静滴头孢呋辛(达力新,深圳致君制药有限公司,价格18.4元/支)100 mg/(kg・d),分2次,治疗3 d,其中98例临床指征明显好转且符合序贯纳入标准[2],①体温消退12 h以上;②咳嗽、呼吸困难明显改善,肺部湿�音减少;③外周血WBC计数恢复正常或CRP0.05),具有可比性(表1)。后续治疗方案:序贯治疗组改为头孢呋辛脂[西力欣,葛兰素史克(中国)投资有限公司规格,价格56.7元/盒] 20 mg/(kg・d),分2次口服治疗;对照组继续静滴头孢呋辛(剂量同前),两组用药均直到症状体征基本消失。
1.3 病情观察
每天由主治医师或主治以上的医师负责在病房或门诊诊查并记录患儿病情,①包括一般情况、呼吸频率、咳嗽、肺部�音等。②实验室检查:治疗前、治疗过程中及疗程结束时查白细胞计数及分类。③治疗前及疗程结束时查肝、肾功能。④记录两组抗生素费用、总住院费用,治疗天数,药品不良反应及并发症发生率。
1.4 疗效判断标准
①痊愈:症状、体征、实验室检查3项均恢复正常者。②显效:临床症状显著减轻,体征消失,实验室检查恢复正常。③有效:临床症状减轻,体征基本消失,实验室检查恢复正常。④无效:临床症状、体征、实验室检查在用药前后无明显改善或加重。以痊愈加显效数计算总有效率。
1.5 统计学处理
采用SPSS1.0软件进行统计学分析,两两比较计量资料采用F检验,计数资料采用卡方检验,P
