摘要
目的 探讨红霉素与阿奇霉素治疗早产儿解脲脲原体(ureaplasma urealyticum,UU)感染的临床疗效与安全性.方法 选择2021年5月至2023年10月徐州市中心医院收治的胎龄＜34周、有临床表现或胸部X线片改变且需要呼吸支持、常规治疗72 h无效、鼻咽拭子UU核酸阳性的早产儿进行前瞻性研究,随机分为红霉素组[30 mg/(kg·d),q8h,静脉滴注]和阿奇霉素组[20 mg/(kg·d)× 3d,继之5 mg/(kg·d),qd,静脉滴注].采用SPSS 20.0统计软件,选用t检验、x2检验、非参数检验和logistic回归分析方法,比较两组患儿治疗的临床疗效与安全性,并分析呼吸支持天数＞14 d的独立影响因素.结果 共纳入89例,其中红霉素组43例,阿奇霉素组46例.与阿奇霉素组相比,红霉素组呼吸支持天数[(22.9±10.0)d 比(18.7±8.5)d]、UU转阴天数[(10.2±3.7)d 比(8.5±3.0)d]、用药天数[(16.4±4.2)d比(14.1±3.8)d]更长,差异均有统计学意义(P＜0.05).两组呕吐/腹泻、喂养不耐受、达全肠内营养日龄、谷丙转氨酶和支气管肺发育不良等比较差异均无统计学意义(P＞0.05),两组均未见心律失常和幽门狭窄.胎龄和治疗药物是呼吸支持天数＞14 d的独立影响因素(P＜0.05).与红霉素相比,阿奇霉素使呼吸支持天数＞14 d的风险降低78.1％.结论 与红霉素治疗早产儿UU感染相比,阿奇霉素能缩短呼吸支持天数、UU转阴天数、抗生素使用天数,降低呼吸支持天数＞14 d的风险,未增加不良反应,但也未能降低支气管肺发育不良发生率.
Abstract
Objective To explore the clinical efficacy and safety of erythromycin and azithromycin in the treatment of ureaplasma urealyticum(UU)infection in preterm infants.Methods A prospective study was conducted in preterm infants with gestational age＜34 weeks,clinical manifestations or changes in chest X-ray requiring respiratory support,failure to respond to conventional treatment for 72 h,and positive UU nucleic acid in nasopharyngeal swabs in Xuzhou Central Hospital from May 2021 to October 2023.They were randomly divided into erythromycin group[30 mg/(kg·d),once every 8 h,ivgtt]and azithromycin group[20 mg/(kg·d)x3 d,followed by 5 mg/(kg·d),once a day,ivgtt].The ttest,x2 test,nonparametric test,and logistic regression analysis were selected by using SPSS 20.0 software.The clinical efficacy and safety were compared,and the independent influencing factors of breathing support＞14 d were analyzed.Results A total of 89 preterm infants were enrolled,including 43 cases in the erythromycin group and 46 cases in the azithromycin group.Compared to the azithromycin group,the erythromycin group exhibited significantly longer durations of respiratory support[(22.9±10.0)d vs.(18.7±8.5)d],UU turning negative[(10.2±3.7)d vs.(8.5±3.0)d],and antibiotic use[(16.4±4.2)d vs.(14.1±3.8)d](all P＜0.05).There were no statistically significant differences in incidence of vomiting or diarrhea,feeding intolerance,and bronchopulmonary dysplasia,the days of reaching total enteral nutrition,and values for glutamic-pyruvic transaminase between the two groups(all P＞0.05).There were no arrhythmia and pyloric stenosis in both groups.The gestational age and therapeutic drugs were independent influencing factors of breathing support＞14 d(all P＜0.05).Compared to erythromycin,azithromycin demonstrates a 78.1％reduction in the risk of requiring breathing support for more than 14 d.Conclusions Compared to erythromycin,azithromycin demonstrates a reduction in the duration of respiratory support,UU conversion time,and antibiotic usage in the treatment of UU infection in preterm infants.Additionally,it lowers the risk of prolonged respiratory support(＞14 d),without increasing adverse reactions.However,it does not decrease the incidence of bronchopulmonary dysplasia.
维普
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