重症监护室抗生素相关性腹泻临床分析

Clinical features of antibiotic-associated diarrhea in intensive care unit

目的分析我院重症监护室患者抗生素相关性腹泻的临床特点及治疗体会,探讨其相关危险因素。方法对2003年7月至2004年12月收住重症监护室的危重患者发生抗生素相关性腹泻的病例进行回顾性分析,并与同期未发生抗生素相关性腹泻患者进行对比。结果192例危重患者中发生抗生素相关性腹泻48例,发生率25%。单因素分析显示抗生素相关性腹泻与患者年龄偏大、APACHEⅡ评分高、住院时间长、白蛋白数值低及多合并有心、肺、肝、肾等慢性疾病史相关,与同期入住监护室未发生抗生素相关性腹泻患者相比差异有统计学意义;而抗生素使用时间与抗生素相关性腹泻的发生无相关性。但多因素分析显示,APACHEⅡ评分、白蛋白水平、慢性疾病患病率为抗生素相关性腹泻的相关危险因素,年龄、住院天数与抗生素相关性腹泻的发生没有显著相关性。结论病情危重程度、慢性疾病史和免疫功能低下是引起抗生素相关性腹泻的相关危险因素。及时的诊断和干预、给予胃肠道保护是治疗抗生素相关性腹泻的重要措施。

Objective To study the clinical features and treatment of antibiotic-associated diarrhea （AAD）, as well as its related factors in the intensive care unit （ICU） of a hospital in Beijing. Methods Patients with antibiotic-associated diarrhea admitted to the ICU at Beijing No. 6 Hospital from July 2003 to December 2004 were retrospectively studied, as compared to those without it during the same period staying in the same ICU at the same hospital. Multivariate logistic regression analysis was used to identify risk factors for AAD. Results Totally, 48 cases with AAD occurred in 192 critically ill patients （25%） during the period. All patients experienced broad spectrum antibiotics. Univariate analysis showed that patients of ADD were older, with more APACHE II score, longer hospital stay, low plasma level of albumin, and more complications of chronic diseases in the heart, lung, liver, kidney, and so on, as compared to those without it, with statistical significance. Days of application of antibiotics did not relate to the occurrence of ADD. Multivariate analysis showed that APACHE 11 score, plasma level of albumin, and history of chronic diseases all were independent risk factors for ADD, but age of the patients and length of their hodpital stay did not significantly relate to it. Conclusions Severity of illness, history of chronic diseases and reduced immune function were independent risk factors for ADD. Timely diagnosis and intervention, including protenction of gastrointestinal tract, were important measures for managing the patients with ADD.