论文部分内容阅读
抗生素相关性肠炎(AAC)多发生在应用抗生素治疗的3～14d,住院患者的发生率为3%～29%。其发病机制为应用抗生素后肠道正常菌群被抑制,致病菌和耐药菌过度生长。主要致病菌为难辨梭状芽孢杆菌,可产生毒素A和毒素B,引起肠黏膜损伤,黏蛋白渗出,导致腹泻;其他有耐甲氧西林金黄色葡萄球菌和克雷伯杆菌等。AAC的临床表现分3型:轻型,呈水样便;重型,黄色或浅绿色水样便,伴腹痛、发热和血白细胞计数升高;暴发型,腹泻,高热,脱水,低蛋白血症,中毒性休克,肠麻痹,甚至肠穿孔。AAC确诊后应停用相关药物,可用甲硝唑和万古霉素治疗,疗程7～10d;也可给予微生态制剂治疗。AAC复发者可采用万古霉素125mg递减疗法;可合用人免疫球蛋白。为预防AAC的发生,应严格掌握抗生素的用药指征,必须用抗生素时应注意监测患者的肠道屏障功能和正常菌群变化,可同时加用谷氨酰胺、精氨酸,以改善肠道免疫功能。
Antibiotics-associated enteritis (AAC) occurs mostly in patients treated with antibiotics for 3 ~ 14d, the incidence of hospitalized patients was 3% to 29%. The pathogenesis of antibiotics is the normal intestinal flora was inhibited, pathogenic bacteria and drug-resistant bacteria overgrowth. The main pathogen is Clostridium difficile can produce toxin A and toxin B, causing intestinal mucosal injury, mucus exudation, leading to diarrhea; other methicillin-resistant Staphylococcus aureus and Klebsiella and so on. AAC clinical manifestations of type 3: light, watery stool; heavy, yellow or light green watery stool, with abdominal pain, fever and white blood cell count increased; fulminant, diarrhea, fever, dehydration, hypoproteinemia, Toxic shock, intestinal paralysis, and even intestinal perforation. AAC diagnosis should be discontinued after the drug can be metronidazole and vancomycin treatment, treatment of 7 ~ 10d; can also be given probiotics treatment. AAC recurrence may be vancomycin 125mg descending therapy; can be combined with human immunoglobulin. In order to prevent the occurrence of AAC, we should strictly grasp the indications of antibiotics, we must pay attention to monitoring the patient’s intestinal barrier function and normal flora changes with antibiotics, can be added with glutamine, arginine, to improve the intestinal tract Immune Function.