老年重症细菌性肺炎患者抗生素相关性腹泻的临床特征与治疗策略  

Clinical analysis and treatment of antibiotic-associated diarrhea in senile patients with severe bacterial pneumonia

作　　者：陈晨 伍三兰 韩勇[1] 刘易慧 

机构地区：[1]华中科技大学同济医学院附属协和医院,武汉市430022

出　　处：《实用医学杂志》2017年第17期2843-2846,共4页The Journal of Practical Medicine

基　　金："十二五"国家科技支撑计划子课题(编号:2013BAI06B04Y041);湖北省卫生计划生育委员会科研项目(编号:WJ2017M118)

摘　　要：目的探讨老年重症细菌性肺炎患者抗生素相关性腹泻(AAD)的临床特征和相关因素,并进一步研究AAD的防治措施。方法对使用抗菌药物治疗后发生AAD的老年重症细菌性肺炎患者的治疗情况进行回顾性分析。结果老年重症细菌性肺炎患者572例中发生AAD患者有114例,发生率19.93%;其中AAD患者中≥80岁占62.28%(n=114)。发生AAD患者曾使用抗菌药物的品种及频率排序为第三代头孢菌素(37.3%)、加酶抑制剂青霉素类(28.6%)、碳青霉烯类(19.2%)、第二代头孢菌素(14.9%)。结论老年重症细菌性肺炎患者发生AAD的高危因素包括:患者高龄、基础疾病严重程度、使用抗菌药物时间、联合用药品种、疾病严重程度(APACHEⅡ)、是否有侵袭性操作。在临床上,合理选择和使用抗菌药物是预防控制老年危重症患者AAD发生的关键。药学监护能更好地帮助优化临床治疗方案,控制减少抗生素相关不良反应。Objective To explore the clinical manifestations, risk factors and treatment of antibiotic asso- ciated diarrhea （AAD） in senile patients with severe bacterial pneumonia. Methods Retrospective analysis was made on senile patients of bacterial pneumonia combined with antibiotic associated diarrhea. Results There were 114 patients out of 572 cases had AAD. The incidence of AAD in these senile patients was 19.93%. There were 62.28% patients more than 80 years old. The incidence AAD was 37.3% with third generation cephalosporin treatment, 28.6% penicillin with enzyme inhibitor treatment and 19.2% with carbopenems treatment. Conclusions The high risk factors of AAD in senile patients with bacterial pneumonia include patient＇ s age, and time, APACHE Ⅱ , category, combination therapyof antibacterial, and invasive operations. We should pay more atten- tion to AAD and related high risk factors when using these antibiotics in clinics. Rational selection and use of anti- bacterial are important measures to stop senile patients from ADD. Pharmaceutical care could help to optimize the treatment plan and reduce its adverse reaction of antibacterial in senile patients.

关 键 词：抗生素相关性腹泻 细菌性肺炎 老年患者 

分 类 号：R563.1[医药卫生—呼吸系统]