布拉氏酵母菌散剂防治小儿急性支气管肺炎抗生素相关性腹泻的疗效分析

Efficacy Analysis of Saccharomyces boulardii in Prevention and Therapy of Antibiotic-associated Diarrhoea in Children with Acute Bronchopneumonia

目的探讨口服布拉氏酵母菌（Saccharomycesboulardii）散剂对防治小儿抗生素相关性腹泻（AAD）的疗效。方法采用随机、对照方法将468例急性支气管肺炎住院患儿分为布拉氏酵母茵干预组（n=233）及空白对照组（n=235），进行为期2周的临床观察。2组均给予针对原发病的标准静脉抗生素治疗。布拉氏酵母茵干预组在基础治疗的同时给予布拉氏酵母菌250mg日2次口服。对照组在出现继发性腹泻后又在原有治疗基础上分为布拉氏酵母菌治疗组和无干预组。结果布拉氏酵母茵组患AAD的风险较空白对照组显著降低[19／233（8．2％）VS63／235（26．8％），RR：0．304，95％CI：0．188～0．492]，尤其是降低了头孢呋辛[5／79（6．3％）vs24／83（28．9％），RR：0．219，95％CI：0．088～0．545]及阿莫西林＋克拉维酸（7／86（8．1％）VS32／91（35．2％），RR：0．231，95％CI：0．108～0．496]治疗中腹泻的风险。空白对照组出现AAD患儿中，布拉氏酵母菌治疗组治疗3d及5d的好转率均显著高于无干预组（3d：81-3％VS19-4％，P〈0．001；5d：93．8％VS22．6％，P〈0．05）。所有病例均未发生明显不良反应或过敏反应。结论布拉氏酵母茵可有效降低急性支气管肺炎患儿AAD发生率，并对AAD有较好的治疗作用。

Objective To discuss the effect of Saccharomyces boulardii （S. boulardii）on prevention and therapy of antibiotic-associated diarrhea （AAD） in children with acute bronchopneumonia. Methods A total of 468 children （aged 6 months to 14 years） with acute bronchopneumonia were included. First, all the children received standard antibiotic treatment and were divided into two groups ： S. boulardii group （n =233 ） and con- trol group （n =235 ）. The children in S. boulardii group received 250 mg of S. boulardii, orally twice daily for the duration of antibiotic treatment. Analyses were based on treatment and included data for 2 weeks＇ observation. Second, the patients in the control group who had AAD during the antibiotic treatment were also divided into two groups ： S. boulardii treatment group and no intervention group. Results Patients receiving S. bou/ar- dii had a lower prevalence of diarrhoea than the control group [ 19 of 233 （ 8.2% ） vs 63 of 235 （ 26.8% ）, relative risk （RR） ： 0.304,95% confidence interval （ CI ） ： O. 188 - 0.492 ], especially the diarrhea risk induced by cefuroxime [ 5/79 （ 6.3% ） vs 24/83 （ 28.9% ）, RR： 0.219,95% CI ： 0.088 - 0.545 ] and amoxicillin＋clavulanate [ 7/86 （ 8.1% ） vs 32/91 （ 35.2% ）, RR： 0.231,95%CI ： O. 108 -0.496 ] was reduced. The improvement rates after 3 days （ 81.3% vs 19.4%, ）（2--24.135, P 〈 0.001 ） and 5 days （93.8% vs 22.6%, X2=32.905, P 〈 0.05 ） of S. bou/ard/i treatment were all significantly higher than that of the no intervention group. No adverse events were observed. Condusion S. boulardii also has good prevention and therapeutical effects on AAD in children with acute bronchoDneumonia.