Clinical Observation on Budesonide Combined with Ganciclovir Treatment of Cytomegalovirus Pneumonia in Children
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目的：探讨布地奈德（普米克令舒，BIS）联合更昔洛韦（GCV）治疗小儿巨细胞病毒（CMV）肺炎的方法及效果。方法：选取我院2009年1月至2012年9月住院确诊的CMV肺炎患儿50例，给予常规综合治疗并随机分为对照组和观察组各25例。对照组单用GCV抗病毒治疗--诱导期：每次5 mg/kg，每12 h 一次静脉滴注，每次滴注时间>1 h，连用2周；维持期：每次10 mg/kg，隔日一次，总疗程4周。观察组采用BIS+GCV治疗：GCV用法用量疗程同对照组，同时加用BIS每次1 mg氧气驱动雾化，每次雾化时间10~15 min，每12 h一次，疗程2周。观察疗效及预后。结果：（1）观察组在缩短住院时间，改善肺部体征、肺部影像学改变、肺外系统损害等方面均优于对照组（P<0.05）；（2）治疗2周后两组总有效率比较差异无统计学意义（P>0.05），但观察组显效率高于对照组（64.0%vs20.0%，P<0.01）；（3）对照组1例（4.0%）发生皮疹，观察组1例（4.0%）出现颜面潮红、烦躁不安，余无明显不良反应发生。结论：小儿 CMV 肺炎常伴有肺外器官系统损害，在常规综合治疗、GCV 抗病毒治疗同时，联合 BIS 雾化治疗，可提高显效率、缩短疗程、改善预后，具有较高安全性。
Objective:To investigate the method and effect that atomization pulmicort respules (BIS) combined with ganciclovir (GCV) therapy cytomegalovirus (CMV) pneumonia in children. Methods: 25 children with CMV pneumonia who treated with BIS + GCV were selected as the treatment group, other 25 cases of CMV pneumonia treated with GCV alone were as control group, observed the two groups in the therapeutic effect and prognosis. Results: Compared with the control group, hospitalization day, recovery of lung symptom, imaging change of lung, damage of other systems, WBC and CRP levels were significantly different from the treatment group (P﹤0.05).As wel as, oxygen saturation, partial pressure of oxygen, carbon dioxide partial pressure were significantly improved in the treatment group(P﹤0.05). After 2 weeks of treatment, the rate of improvement such as recovery of lung symptom, imaging change of lung, damage of other systems,which were in treatment group. Furthermore, oxygen saturation, partial pressure of oxygen, carbon dioxide partial pressure were turned more favourable in treatment group(P﹤0.05). While, there were no difference between the two groups in WBC and CRP levels(P﹥O.05). The efficiency rate of treatment group was significantly higher than that of control group(χ2=9.934,P=0.002). There were no other specific adverse reactions except only one child (4%) appeared facial flushing and restless. Conclusion:CMV pneumonia regularly accompanied with other organ or system damages in children. The treatment of conventional GCV virus combined with BIS atomization and comprehensive care not only improved the cure rate and prognosis, but also cut down hospitalization course, further more, its security was reliable.
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