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目的:评价我院抗菌药物治疗儿童社区获得性肺炎(CAP)的疗效并进行成本-效果分析,为临床提供参考。方法:将我院2012年1月至2013年1月收治的202例中、重度CAP患儿,按抗菌药物治疗方案分为五组———Ⅰ组(37例):头孢呋辛钠+阿奇霉素;Ⅱ组(32例):头孢噻肟钠+阿奇霉素;Ⅲ组(48例):头孢哌酮钠/舒巴坦钠+阿奇霉素;Ⅳ组(44例):头孢他啶+阿奇霉素;Ⅴ组(41例):头孢吡肟+阿奇霉素。评价各组临床疗效和不良反应,并进行成本-效果分析。结果:五组总有效率分别为75.68%、78.13%、85.42%、86.36%、82.93%,病原菌清除率分别为76.47%、78.57%、82.61%、85.71%、84.21%,不良反应发生率分别为2.70%、3.13%、4.17%、4.55%、4.88%,组间比较差异均无统计学意义(P均>0.05)。应用经济学原理分析显示Ⅰ组成本最小(539.35元),Ⅴ组最大(626.36元);计算各组的C/E值,Ⅳ组最小(6.80),Ⅴ组最大(7.55);以成本最小的Ⅰ组为参照计算各组△C/△E值,Ⅳ组最小(4.49),Ⅴ组最大(12.00)。结论:五组总有效率、细菌清除率和不良反应发生率相当,但Ⅳ组(头孢他啶+阿奇霉素)最经济,为治疗儿童CAP的首选方案。
OBJECTIVE: To evaluate the efficacy of antibacterials in treating children with community-acquired pneumonia (CAP) in our hospital and to conduct cost-benefit analysis to provide a reference for clinical practice. Methods: 202 cases with moderate and severe CAP admitted to our hospital from January 2012 to January 2013 were divided into five groups according to the antibacterial therapy regimen --- group Ⅰ (37 cases): cefuroxime sodium plus azithromycin ; Group Ⅱ (32 cases): cefotaxime sodium plus azithromycin; group Ⅲ (48 cases): cefoperazone sodium / sulbactam sodium plus azithromycin; group Ⅳ (44 cases): ceftazidime plus azithromycin; group V Pyxime + azithromycin. Evaluation of clinical efficacy and adverse reactions in each group, and cost-effectiveness analysis. Results: The total effective rates of the five groups were 75.68%, 78.13%, 85.42%, 86.36% and 82.93% respectively. The pathogenic bacteria clearance rates were 76.47%, 78.57%, 82.61%, 85.71% and 84.21% respectively. The incidences of adverse reactions were 2.70%, 3.13%, 4.17%, 4.55%, 4.88% respectively. There was no significant difference between the two groups (P> 0.05). According to the principle of applied economics, the cost of group Ⅰ was the lowest (539.35 yuan) and that of group V was the highest (626.36 yuan); the C / E of each group was calculated, the minimum of group Ⅳ (6.80) and the group of Ⅴ (7.55) Group Ⅰ was used as a reference to calculate the △ C / △ E values of each group, the minimum in group Ⅳ (4.49) and the maximum in group V (12.00). Conclusion: The total effective rate, bacterial clearance rate and incidence of adverse reactions in the five groups are similar, but Ⅳ group (ceftazidime plus azithromycin) is the most economical choice for the treatment of CAP in children.