110例抗生素相关性腹泻的临床研究

A clinical study of 110 cases of antibiotic-associated diarrhea

目的探讨抗生素相关性腹泻的临床特征及预防对策。方法回顾性分析1680例住院应用抗菌药物患者的临床资料,统计抗生素相关性腹泻发生率;分析与抗菌药物应用关系,探讨影响因素;观察治疗及预后。结果抗生素相关性腹泻发生率6.55%;粪便性状以稀水泡沫样便为主,占72.73%,伴有黏液(含脓血)及黏膜脱落坏死各占24.54%、2.73%;抗菌药物为常规剂量,共5类16个品种,按照发生频率依次为头孢三代、青霉素类、碳青霉烯类、头孢二代、克林霉素,分别占42.73%、20.91%、18.18%、14.54%、3.64%;影响因素:年龄大、抗菌药物应用种类多及时间长、采用干预措施(P<0.05),与给药途径、预防抗菌药物无关;治疗后107例腹泻缓解,3例死亡,死亡率2.73%。结论抗生素相关性腹泻的发生率较高,与多种因素有关,应合理选择抗菌药物;减少联合用药,避免预防应用抗菌药物;减少侵入性操作;应用抗菌药物的患者可补充益生菌。

OBJECTIVE To explore the clinical characteristics and preventive measures of antibiotic-associated diarrhea（AAD）.METHODS A retrospective analysis of clinical data of 1680 hospitalized patients who were treated with antibiotics was conducted and the incidence of AAD was counted.The treatment and prognosis of patients were observed,and also the influential factors were discussed by analyzing the correlation between AAD and use of antibiotics.RESULTS The incidence of AAD achieved 6.55%;concerning property of stool,loose foamy stool was predominant,accounting for 72.73%,accompanied by mucus,including the symptom such as purulent blood,in 24.54% and shedding and necrosis of mucosa in 2.73%.Antibiotics were used at regular doses,including a total of 16 different drugs in five types.According to the frequency,the third-generation cephalosporins,penicillin,carbapenems,the second-generation cephalosporins,and kerlin amphotericin were used in 42.73%,20.91%,18.18%,14.54% and 3.64%,respectively.Influential factors included： old age,the types of antibiotics,long-term use and adopting intervention measures（P〈0.05）;it was not related to administration route or prophylactic antibiotics.Diarrhea in 107 cases was relieved after the treatment.There were 3 cases of death,with mortality of 2.73%.CONCLUSION A high incidence of AAD is associated with many factors.Proper application of antibiotics,reducing combination treatment,avoiding antibiotics as preventive medicine,reducing invasive operation,and supplementing probiotics can be taken as measures to prevent AAD.