68例伪膜性肠炎临床及内镜特点分析  

Clinical and Endoscopic Features of Pseudomembranous Colonitis:An Analysis of 68 Cases

作　　者：殷桂香[1] 乔进朋[1] 殷芳[1] 杨泽敏[1] 

机构地区：[1]北京丰台医院消化内科,北京市100071

出　　处：《中国医院用药评价与分析》2010年第6期540-542,共3页Evaluation and Analysis of Drug-use in Hospitals of China

摘　　要：目的:分析68例伪膜性肠炎的临床及内镜特点,提高临床医生对该病的认识。方法:68例伪膜性肠炎患者按年龄分组,对两组临床资料进行回顾性分析。结果:老年组47例(69.12%),中年组21例(30.88%)。老年组病情危重20例(42.55%)、合并严重慢性基础疾病者43例(91.49%)比例明显高于中年组(P<0.025)。导致伪膜性肠炎最多的抗生素为克林霉素,其余依次为第3代头孢菌素、氟喹诺酮类、第2代头孢菌素和其他β-内酰胺类,老年组与中年组差异无显著性(P值均>0.05)。结肠镜下对病灶活检进行厌氧培养,阳性率为82.5%(33/40),明显高于粪便厌氧培养5.88%(4/68),(P<0.05)。68例伪膜性肠炎患者经停用或更换抗生素,给予甲硝唑/奥硝唑、盐酸万古霉素、微生态制剂治疗后痊愈64例(94.12%);好转3例(4.41%);死亡1例(1.47%)。结论:(1)伪膜性肠炎是抗生素相关性肠炎中的严重表现;(2)年老、免疫功能低下、合并严重慢性基础疾病等为高危因素;(3)结肠镜检查是诊断伪膜性肠炎的首选方法;(4)凡应用抗生素期间突然出现的严重腹泻者,均应考虑难辨梭状芽孢杆菌感染的可能。OBJECTIVE：To analyze the clinical and endoscopic features of pseudomembranous colonitis（PMC）,and facilitate clinicians understanding on this disease.METHODS：A total of 68 patients with pseudomembranous colonitis were assigned to two groups according to age difference,and the clinical data of the two groups were analyzed retrospectively.RESULTS：There were 47 cases（69.12%） in older age-group versus 21 cases（30.88%） of the middle-aged group.In the older age group,20（42.55%） were critical cases and 43（91.49%） had serious chronic underlying diseases,both were significantly higher than in the middle-aged group（P 0.025）.Clindamycin was the chief antibiotics that lead topseudomembranous enteritis,followed by the third generation cephalosporins,quinolones,the second generation cephalospoins and betalactams,and the differences between the two groups were nonsignificant（all P 0.05）.Anaerobic culture of focus nidus performed under electronic colonoscope revealed a significantly higher positive rate than did the anaerobic culture of stools [82.5%（33 /40） vs.5.88%（4 /68）,P 0.05].On withdrawal or replacing antibiotics with metronidazole /ornidazole,vancomycinornidazoleand intestinal probiotics,64 cases（94.12%） had cures,3 cases（4.41%） had improvement,and 1 case（1.47%） died.CONCLUSION：（1） PMC is a serious condition of the antibiotic-associated colitis;（2） older age,lower immune function,associated serious chronic disease are high risk factors of PMC;（3） Endoscopy is the most effective method for diagnosing PMC;（4） The possibility of clostridium difficile enterocolitis should be considered if patients present with severe diarrheas during antibiotic treatment.

关 键 词：伪膜性肠炎 结肠镜检查 分析 

分 类 号：R978.1[医药卫生—药品]