Clinical Study On Early Application Of Methylprednisolone In The Treatment Of Severe Mycoplasma Pneumoniae Pneumonia In Children

Objective:To investigate the clinical effect of glucocorticoid in the early treatment of SMPP in children.Methods:The object of this study was children who were diagnosed SMPP in Chengde Central Hospital from November 2017 to January 2019.According to the application timing of methylprednisolone sodium succinate,they were divided into early group and late group.The early group was administrated with methylprednisolone sodium succinate in the early stage??7 days?.The late group was administrated in the late stage?>7 days?.Based on the definite diagnosis of MPP,SMPP can be diagnosed in accordance with any of the following criteria:a)Obvious shortness of breath or tachycardia?1-5 years old:RR?40 times/min,HR?140 beats/min;above 5 years old:RR?30times/min,HR?120 beats/min?,with or without dyspnea?flaring of alaenasi,three depressions sign?and cyanosis;b)Being ineffective after effective use of macrolides for more than a week?persistent axillary temperature?38.5?or no improvement or even progress in pulmonary imaging?,or persistent fever lasts more than 10 days;c)Chest imaging shows multi-lobe/segment involvement or more than 2/3 in single lobe;d)Pleural effusion,atelectasis,pulmonary necrosis/pulmonary abscess or other pulmonary complications;e)Hypoxemia,under the condition of inhaling air,pulse oxygen saturation?SaO₂??0.92;f)Complicated with other serious functional impairments?central nervous system infection,heart failure,myocarditis,gastrointestinal hemorrhage,obvious electrolyte or acid-base balance disorder,etc.?.In this study,120 cases of SMPP children were screened.109 cases were actually enrolled,including 61 cases in the early group,3 cases in the automatic discharge group,48 cases in the late group,and 8 cases in the automatic discharge group.The differences of cure rates,hospitalization time,fever abatement time,spasmodic cough remission time,disappearance time of pulmonary rales,recovery of inflammatory indexes and improvement of imaging between the two groups were compared.Results:1 The cure rates of the early group and the late group were 31.1%and10.4%,respectively.The cure rates of the early group were higher than that of the late group.The difference between the two groups was statistically significant??²=6.72,P<0.05?.The hospitalization time were?13.12±1.20?d and?13.83±1.14?d,respectively.The hospitalization time of the early group was shorter than that of the late group.The difference between the two groups was statistically significant?t=3.18,P<0.01?.2 The fever abatement time after using methylprednisolone of the early group and the late group were?6.98±2.17?h and?8.27±1.95?h,respectively.The fever abatement time of the early group was shorter than that of the late group.The difference between the two groups was statistically significant?t=3.21,P<0.01?.The spasmodic cough remission time were?8.53±2.35?d and?9.48±1.62?d,respectively.The spasmodic cough remission time in the early group was shorter than that in the late group.The difference between the two groups was statistically significant?t=2.40,P<0.05?.3 The disappearance time of pulmonary rales in the early group and the late group were?7.00±2.21?d and?8.46±2.05?d,respectively.The disappearance time of pulmonary rales in the early group was shorter than that in the late group.The difference between the two groups was statistically significant?t=3.53,P<0.01?.4 CRP in the early group and the late group were?7.25±1.71?mg/L and?10.00±1.47?mg/L,respectively.LDH were?209.98±46.82?U/L and?229.98±55.45?U/L,respectively.These inflammatory indexes in the early stage group fell better than those in the late stage group.The differences in LDH were statistically significant?t=2.14,P<0.05?.The differences in CRP were statistically significant?t=8.87,P<0.01?.5 The display rate of imaging of the early group and the late group were39.3%and 20.8%,respectively.The display rate of imaging of the early group was higher than that of the late group.The difference between the two groups was statistically significant??²=4.29,P<0.05?.Conclusion:Early application of glucocorticoid in SMPP of children?within one week?can improve the cure rate,shorten the hospitalization time and fever time,alleviate spasmodic cough quickly,promote the absorption of pulmonary rales,and improve the recovery of inflammatory indexes and imaging.It is worthy of clinical promotion.