摘要
抗生素相关性肠炎(AAC)多发生在应用抗生素治疗的3～14d,住院患者的发生率为3%～29%。其发病机制为应用抗生素后肠道正常菌群被抑制,致病菌和耐药菌过度生长。主要致病菌为难辨梭状芽孢杆菌,可产生毒素A和毒素B,引起肠黏膜损伤,黏蛋白渗出,导致腹泻;其他有耐甲氧西林金黄色葡萄球菌和克雷伯杆菌等。AAC的临床表现分3型:轻型,呈水样便;重型,黄色或浅绿色水样便,伴腹痛、发热和血白细胞计数升高;暴发型,腹泻,高热,脱水,低蛋白血症,中毒性休克,肠麻痹,甚至肠穿孔。AAC确诊后应停用相关药物,可用甲硝唑和万古霉素治疗,疗程7～10d;也可给予微生态制剂治疗。AAC复发者可采用万古霉素125mg递减疗法;可合用人免疫球蛋白。为预防AAC的发生,应严格掌握抗生素的用药指征,必须用抗生素时应注意监测患者的肠道屏障功能和正常菌群变化,可同时加用谷氨酰胺、精氨酸,以改善肠道免疫功能。
Antibiotic-associated colitis （AAC） mainly occurs 3 to 14 days after the initiation of antibiotic treatment. The incidence among inpatients is 3%-29%. The underlying pathological change of AAC is imbalance of intestinal flora caused by application of broad-spectrum antibiotics. The pathogenesis mechanism is that antibiotics suppress the normal intestinal flora,and then excessive growth of pathogenic and resistant bacteria occurs. The main pathogenic bacterium is Clostridium difficile（CD）,which produces toxin A and toxin B that injure the intestinal mucosa,make mucin leak,and eventually cause diarrhea. Except CD,methicillin resistant Staphylococcus aureus （MRSA） and Klebsiella species are also pathogenic bacteria of AAC. According to the clinical manifestations,AAC can be divided into three types：mild type characterized by watery diarrhea,severe type by yellow or light green watery diarrhea,abdominal pain,fever,and elevated white blood cells,and fulminant type by diarrhea,high fever,dehydration,hypoproteinemia,toxic shock,intestinal paralysis,even acute intestinal perforation. After the diagnosis of AAC is confirmed,the drugs being in use should be withdrawn immediately. Treatment of metronidazole and vancomycin for 7-10 days can be given,and probiotics can be utilized in addition. For the recurrent cases,vancomycin can be used at a dosage of 125 mg in a regressive manner,and combined with human immune globulin therapy. In order to prevent AAC,the drug indication for antibiotics should be strictly controlled clinically. When the use of broad-spectrum antibiotics are neccessary,the intestinal barrier function and normal flora should be monitored. Glutamine and arginine can be added to improve the intestinal immune function.
出处
《药物不良反应杂志》
2010年第4期262-268,共7页
Adverse Drug Reactions Journal
关键词
抗生素相关性肠炎
发病机制
治疗与预防
antibiotic-associated colitis
pathogenesis
treatment and prevention
