“清宣通络”法治疗儿童大环内酯类耐药肺炎支原体肺炎的临床疗效观察

Clinical observation of the "Qingxuan Tongluo" method in the treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children

摘要

目的 观察“清宣通络”法治疗儿童大环内酯类耐药肺炎支原体肺炎的临床疗效。方法 选取2024年11月天津中医药大学第一附属医院收治住院的大环内酯类耐药肺炎支原体肺炎患儿120例为研究对象, 按随机数字表法分为观察组与对照组各60例。两组抗感染药物选择大环内酯类抗生素。入组病例均为风热闭肺证, 对照组以“宣肺开闭, 止咳平喘”法治疗, 为传统银翘散合麻杏石甘汤加减, 证型转为痰热闭肺证则予五虎汤合葶苈大枣泻肺汤加减治疗；观察组以“清宣通络”法指导下的清宣通络方加减治疗。两组疗程均为14 d。比较两组疾病疗效、临床痊愈时间、完全退热时间、咳嗽咳痰缓解时间、中医证候积分、单项症状体征消失率、安全性评价。结果 观察组脱落3例, 对照组脱落4例。观察组患儿愈显率为75.4%（43/57）, 高于对照组57.1%（32/56）, 差异有统计学意义（P<0.05）。观察组患儿临床痊愈时间、完全退热时间、咳嗽咳痰缓解时间均低于对照组, 差异有统计学意义（P<0.05）。观察组患儿中医证候临床痊愈率为47.3%（27/57）, 高于对照组28.6%（16/56）, 差异有统计学意义（P<0.05）。两组在临床痊愈时, 发热症状均100%消失, 观察组咳嗽、喉间痰鸣、痰稠难咳症状的消失率高于对照组, 差异均有统计学意义 (P<0.05)；两组患儿不良反应发生率比较差异无统计学意义（P>0.05）。结论 “清宣通络法”治疗儿童大环内酯类耐药肺炎支原体肺炎能够明显缩短患儿退热时间、咳嗽缓解时间、临床痊愈时间, 提高疾病愈显率, 临床应用安全性较好。

Abstract

Objective To observe the clinical efficacy of the "Qingxuan Tongluo" method (clearing, diffusing, and unblocking collaterals) in the treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children. Methods A total of 120 pediatric inpatients with macrolide-resistant Mycoplasma pneumoniae pneumonia, admitted to the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from November 2024, were enrolled and randomly divided into an observation group and a control group, with 60 cases in each group. Macrolide antibiotics were used as the anti-infective therapy in both groups. All included cases were diagnosed with the pattern of wind-heat obstructing the lung. The control group received treatment based on the principle of "ventilating the lung, opening the blockage, relieving cough, and calming wheezing", using a modified Yinqiao powder combined with Maxing Shigan decoction. If the pattern shifted to phlegm-heat obstructing the lung, Wuhu decoction and Tingli Dazao Xiefei decoction were administered instead. The observation group was treated with the modified Qingxuan Tongluo formula, under the guidance of the "Qingxuan Tongluo" method. The treatment course lasted 14 days in both groups. Comparisons were made between the two groups regarding therapeutic efficacy, clinical recovery time, time to complete defervescence, time to relief of cough and sputum, traditional Chinese medicine (TCM) syndrome scores, disappearance rates of individual symptoms and signs, and safety evaluation. Results Three cases dropped out from the observation group and four from the control group. The cure and marked response rate was 75.4% (43/57) in the observation group, which was significantly higher than that in the control group [57.1% (32/56), P<0.05]. The clinical recovery time, time to complete defervescence, and time to relief of cough and sputum in the observation group were all significantly shorter than those in the control group (P<0.05). The clinical recovery rate based on TCM syndrome scores was 47.3% (27/57) in the observation group, significantly higher than that in the control group [28.6% (16/56), P<0.05]. At the time of clinical recovery, fever resolved in 100% of patients in both groups; the disappearance rates of cough, laryngeal wheezing, and sticky, difficult-to-expectorate sputum were significantly higher in the observation group than in the control group (P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion The "Qingxuan Tongluo" method for the treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children can significantly shorten the time to defervescence, the time of cough relief, and clinical recovery time, and increase the cure and marked response rate, which demonstrates favorable clinical safety.

关键词

大环内酯类耐药肺炎支原体肺炎 / “清宣通络”法 / 疗效观察 / 儿童

Key words

Macrolide-resistant Mycoplasma pneumoniae pneumonia (MRMPP) / "Qingxuan Tongluo" method / Efficacy observation / Child

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基金资助

国家自然科学基金项目(82575140, 82474571)

天津市科学技术局多元投入基金项目重点项目(21JCZDJC01130)

国家中医药管理局中西医结合与少数民族医药司项目(2023368)

天津市南开区中医药传承创新发展示范试点项目(202402044018)