内科系统的伪膜性肠炎的内镜与临床特征

Clinical Features and Endoscopic Findings of Antibiotic-associated Pseudomanbranous Colonitis

目的探讨抗生素所致伪膜性肠炎(pseudrmembranous colitis,PMC)的临床及内镜下特征,以提高诊治水平。方法对我院近3年来内科诊治的17例PMC进行回顾性分析。结果PMC多发于合并有长期慢性疾病、年龄大、体质差及抗生素应用不规范的老年患者,17例病人中,14例系老年重症患者。全部患者均在使用广谱抗生素过程中出现腹泻、腹痛、血便等症状。均接受结肠镜检查,提示为PMC。结论结肠镜检查是诊断PMC快速而可靠的方法。对长期大量使用抗生素的老年或重病患者出现腹痛、腹泻时,首先要考虑有无PMC,应尽快行内镜检查,一旦确诊要及早停用抗生素,使用足量、足疗程的甲硝唑、万古霉素和相应的微生态制剂是治疗PMC的有效方法。

Objective To analyze the clinical and endoscopic features of antibiotic-associated pseudomembranous colitis, and summarize clinical lessons, in order to improve the level of diagnosis and treatment. Methods The clinical data of 17 patients with antibiotic-associated pseudomembranous colitis in Second Affiliated Hospital of PLA General Hospital from 2004 to 2008 were analyzed retrospectively according to their respective ages, complications, types of antibiotics, time of onset and treatments, et al. Results Pseudomembranous colitis was a common gastrointestinal complication in old patients with chronic diseases and body weakness, especially in those with antibiotic abusing. Conclusion Antibiotic abusing is the main cause of pneudomambranous colitis. Most of the symptoms in the old patients treated with superfluous antibiotics are exhibited as abdominal pain and watery diarrhea. The diagnosis can be confirmed by sigmoidoscopic features. It can be treated successfully with oral vancomycin and metronidazole after prompt withdrawal of antibiotics.