老年病人难辨梭状芽胞杆菌性结肠炎的诊治

CLINICAL INVESTIGATION OF CLOSTRI DIUM DIFFICILE COLITIS IN GERIATRIC PATIENTS

目的探讨老年病人难辨梭状芽胞杆菌性结肠炎的病因、诊断及防治措施。②方法对８例老年病人难辨梭状芽胞杆菌性结肠炎进行回顾性分析，采用Ｇｅｏｒｇｅ方法对难辨梭状芽胞杆菌分离、鉴定，仿Ｃｈａｎｇ法行细胞毒素测定。③结果本组病人所用抗生素的种类繁多，以头孢菌素类和氨苄西林最多，在使用抗生素后３～１４ｄ内发生腹泻，重者伴腹膜炎。４例行纤维结肠镜检查均见有小片至大斑片假膜附着，严重者融合成片。治疗措施为停用原抗生素，应用万古霉素和（或）甲硝唑及加强支持疗法。８例中治愈７例，死亡１例。④结论老年人特别是术后使用广谱抗生素者易诱发难辨梭状芽胞杆菌性结肠炎。

Objective\ To investigate etiology, diagno sis, prevention and treatment of clostridium difficile colitis in geriatric pati ents.\ Methods\ A retrospective analysis on 8 cases of geriatric clostrid ium difficile colitis was made. Clostridium difficile was isolated and confirm ed by using George method. Cytotoxins were tested by adopting mimic Chang m ethod. \ Results The patients in this study used variety of antibiotics with the predominance of cephalosporin and ampicillin. Diarrhea appeared 3 to 4 days after using antibiotics and in severe cases peritonitis ensued. In 4 c ases, fibrocolonoscopic findings revealed small pieces or large paches of pseudo membrane. Therapeutic intervention included cessation of primary antibiotics and application of vancomycin or metronidzole with intensive supportive th erapy. Of the 8 cases, 7 recovered and 1 died.\ Conclusion\ Senile patients, especilly those using broad spec trum antibiotics after operation were high risking for clostridium difficile colitis.