楊紅麗+梁雯+金燕會(huì)

【摘要】目的探討白細(xì)胞非升高性上呼吸道感染的抗生素治療及中藥治療效果, 以提高合理用藥。方法對(duì)858例白細(xì)胞非升高性上呼吸道感染患者進(jìn)行分組治療觀察, 隨機(jī)分為抗生素治療組429例和中藥治療組429例。兩組均采用一般支持和對(duì)癥治療, 抗生素組加用羅紅霉素膠囊0.15 b.i.d.口服(此組均無大環(huán)內(nèi)脂類抗生素過敏史), 中藥治療組加用中藥清熱解毒口服液或雙黃連口服液10~20 ml t.i.d.口服。結(jié)果兩組治療時(shí)間均為3~7 d。羅紅霉素治療組治愈312例, 顯效99例, 無效18例, 總有效率95.80%；中藥治療組治愈324例, 顯效84例, 無效21例, 總有效率95.10%；兩組療效比較差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。結(jié)論白細(xì)胞非升高性上呼吸道感染的治療, 無需應(yīng)用抗生素, 在對(duì)癥、支持的基礎(chǔ)上輔以中藥治療即可。

【關(guān)鍵詞】上呼吸道感染；病毒；抗生素；耐藥性

Clinical observation on 858 cases of non-elevated white blood cell of upper respiratory tract infectionYANG Hong-li, LIANG Wen, JIN Yan-hui. Beijing Puren Hospital, Beijing 100062, China

【Abstract】Objective To investigate the effect of antibiotic therapy and traditional Chinese medicine in the treatment to non-elevated white blood cell of upper respiratory tract infection, in order to improve the rational use of drugs. Methods There were 858 cases of non-elevated white blood cell of upper respiratory tract infection treated with observation group who were randomly divided into the antibiotics treatment group in 429 cases and the antibiotic treatment group of Chinese medicine in 429 cases. Two groups were given general support and symptomatic treatment,antibiotic group was added with roxithromycin capsules 0.15 BID oral ( this group were not macrolide antibiotic allergy historiclly), group of traditional Chinese medicine was treated with traditional Chinese medicine for Qingre Jiedu oral liquid or 10-20 ml TID oral Shuanghuanglian oral liquid. Results Treatment of two groups lasted 3~7day. Roxithromycin treatment group: 312 cases were cured, 99 cases effective, 18 cases ineffective, the total effective rate was 95.80%; Chinese medicine treatment group: 324 cases were cured, 84 cases effective, 21 cases ineffective, the total effective rate was 95.10%; the effect difference of two groups have no statistical significance(P>0.05). Conclusion There is no need application of antibiotics treating upper respiratory tract infection, for using traditional Chinese medicine against the symptomatic is enough.

【Key words】Upper respiratory tract infection; Virus; Antibiotics; Resistance急性上呼吸道感染是指鼻腔、咽或喉部急性炎癥的概稱。常見病因?yàn)椴《? 少數(shù)由細(xì)菌引起［1］。臨床診治上呼吸道感染, 除了結(jié)合臨床癥狀及體征外, 一般常參考血常規(guī)白細(xì)胞是否升高來大概劃分病毒性或是細(xì)菌性感染。白細(xì)胞升高一般多為細(xì)菌性感染所致, 白細(xì)胞正?；蚪档投酁椴《拘曰蛑гw等感染所致。血白細(xì)胞升高者臨床一般多用抗生素治療, 但血白細(xì)胞正?；蚪档驼叩闹委熢撊绾魏侠碛盟幠兀孔髡呔痛诉M(jìn)行了觀察, 現(xiàn)報(bào)告如下。

1資料與方法

1. 1一般資料選擇門診診斷為急性上呼吸道感染患者858例, 年齡15~89歲, 其中男性415例, 女性443例。主要臨床表現(xiàn)有發(fā)熱、咳嗽、咽痛、流涕等。血常規(guī)表現(xiàn)為白細(xì)胞正?；蚱? 中性粒細(xì)胞正?；蚱?。

1. 2診斷方法根據(jù)病史、流行情況、鼻咽部發(fā)生的癥狀和體征, 結(jié)合周圍血象和胸部X線檢查可作出臨床診斷［1］。

1. 3治療方法隨機(jī)分為抗生素治療組429例和中藥治療組429例。兩組均采用一般支持和對(duì)癥治療, 抗生素組加用羅紅霉素片0.15 b.i.d.口服(此組均無大環(huán)內(nèi)脂類抗生素過敏史), 中藥治療組加用中成藥清熱解毒口服液或雙黃連口服液10~20 ml t.i.d.口服。

1. 4療效評(píng)定標(biāo)準(zhǔn)治愈：臨床癥狀、體征消失, 白細(xì)胞及其分類正常；顯效：病情明顯好轉(zhuǎn), 臨床癥狀、體征消失, 白細(xì)胞及其分類基本正常；無效：癥狀及體征均無改善或加重?？傆行?治愈率+顯效率。

1. 5統(tǒng)計(jì)學(xué)方法采用SPSS18.0統(tǒng)計(jì)學(xué)軟件處理數(shù)據(jù), 計(jì)數(shù)資料采用χ2檢驗(yàn), P<0.05為差異有統(tǒng)計(jì)學(xué)意義。

2結(jié)果

兩組治療時(shí)間均為3~7 d。羅紅霉素治療組治愈312例, 顯效99例, 無效18例, 總有效率95.80%；中藥治療組治愈324例, 顯效84例, 無效21例, 總有效率95.10%；兩組療效比較差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。

3討論

急性上呼吸道感染約90%的病原為病毒, 另有約10%的病原為A族鏈球菌、流感嗜血桿菌、葡萄球菌、支原體或衣原體［2］。治療急性上呼吸道感染首先要分清病原, 對(duì)占90%的病毒應(yīng)以中藥治療為主, 對(duì)細(xì)菌、支原體或衣原體感染可應(yīng)用相應(yīng)抗生素治療［2］。在國(guó)內(nèi)針對(duì)性的病毒檢測(cè)技術(shù)不很普及, 大多采取血常規(guī)等檢測(cè)作為臨床診治參考。血常規(guī)白細(xì)胞升高者大多按細(xì)菌感染治療, 血常規(guī)白細(xì)胞正常或降低者多按病毒或肺炎支原體(mycoplasma pneumonia, MP)等感染治療。文獻(xiàn)報(bào)道［3］, MP感染后白細(xì)胞計(jì)數(shù)正常, 中性粒細(xì)胞絕對(duì)值增高。因MP的檢測(cè)也不普及, 故臨床醫(yī)生對(duì)血常規(guī)白細(xì)胞正常的上呼吸道感染患者常經(jīng)驗(yàn)性用大環(huán)內(nèi)脂類抗生素治療。作者針對(duì)白細(xì)胞非升高性的上呼吸道感染進(jìn)行了上述研究, 其結(jié)果發(fā)現(xiàn)：抗生素治療組療效并不優(yōu)于中藥治療組, 兩組比較差異無統(tǒng)計(jì)學(xué)意義?？股氐膽?yīng)用可增加耐藥性的產(chǎn)生［4, 5］, 多資料［6-8］提倡不用抗生素或延后應(yīng)用抗生素治療上呼吸道感染為佳。中藥清熱解毒口服液及雙黃連口服液有一定的抗炎、抗病毒作用［9, 10］, 且服用方便, 患者的依從性較高。故針對(duì)白細(xì)胞非升高性上呼吸道感染的治療, 無需應(yīng)用抗生素, 在對(duì)癥、支持的基礎(chǔ)上輔以中藥治療即可。

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［收稿日期：2014-04-03］

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