伪膜性肠炎27例临床分析

Clinical Analysis of 27 Cases of Pseudomembranous Colitis

目的通过对抗生素所致的伪膜性肠炎(pseudomembranous colitis,PMC)的分析,总结临床经验教训,提高临床对伪膜性肠炎的诊治水平。方法回顾性分析伪膜性肠炎患者27例临床资料,内容包括年龄、性别、合并疾病、抗生素应用情况、临床表现和诊断、治疗方法等方面。结果不27例伪膜性肠炎的住院患者平均年龄69.7岁,22例有基础疾病(81.48%),其中结肠镜检查轻型者11例(40.74%),中型者14例(51.85%),重型2例(7.41%)。而且有基础疾病的患者年龄偏大,65岁以上者占66.7%,发病前均有长期、大量、反复应用抗生素以及不合理应用抗生素等因素。结论不合理应用抗生素是引发伪膜性肠炎的主要原因。对长期大量使用抗生素的患者出现腹痛、腹泻时,应警惕有无PMC,及时停用抗生素,足量、足疗程使用甲硝唑和万古霉素是PMC的有效治疗方法。

Objective To analyze the clinical features of antibiotic-associated pseudomembranous colitis（PMC） and to summarize clinical experience,in order to improve the level of diagnosis and treatment of PMC.Methods A retrospective analysis was carried out in 27 cases of PMC according to their age,gender,complications,use of antibiotics,clinical manifestations and diagnosis,treatment methods and so on.Results There were 27 patients diagnosed as PMC and the average age was 69.7.Of them,22 patients（81.48%） had underlying disease,of which,11 cases（40.74%） were wild,14（51.85%） moderate and 2（7.41%） severe based on the colonoscopic findings.Patients with underlying disease were basically older,those more than 65 years accounting for 66.7%,and all had a history of long-term,repeated and irrational use of antibiotics.Conclusion Irrational use of antibiotics is the major cause of PMC.For patients who developed abdominal pain and diarrhea after prolonged use of antibiotics,PMC should be highly suspected,and antibiotics should be abandoned promptly.Adequate vancomycin and metronidazole are effective for PMC after sufficient treatment courses.