18 例伪膜性肠炎内镜及临床特点研究.docVIP

18 例伪膜性肠炎内镜及临床特点研究[摘要] 目的：探讨伪膜性肠炎（pseudrmembranous colitis，PMC）患者的临床表现及内镜特点，提高诊治水平。方法：对本院6年来诊治的18例PMC患者的临床资料进行回顾性分析。结果：PMC是一种长期应用抗生素的并发症，易发生在长期慢性疾病、年龄大、体质差及抗生素应用不规范的患者，表现为腹泻、腹痛、血便等症状，结肠镜检查发现多数患者伪膜呈连续性或散在性分布。结论：抗生素不规范应用是主要病因，尤其老年及重症患者，结肠镜检查是诊断PMC快速而可靠的方法，治疗应停用相关抗生素口服甲硝唑、万古霉素和益生菌是治疗PMC有效方法。 [关键词] 伪膜性肠炎；临床特点；结肠镜；临床分析 [中图分类号] R516.1 [文献标识码] A [文章编号] 1674-4721（2012）01（b）-180-02 Endoscopic and clinical analysis of 18 patients with Pseudomanbranous Colonitis WU Lijuanm, ZHAO Yongjie, DONG Caihong, QIAO Nana Department of Endoscope Center，the First Affiliated Hospital of Henan University of Science and Technoligy, Luoyang 471003，China [Abstract] Objective: To analyze the clinical manifestationand endoscopic features of PMC，and to improve the level of diagnosis and treatment． Methods: The clinical data of 18 cases of patients with PMC was analyzed retrospectively in recent 6 years． Results: Pseudomembranous colitis was a common intestinal complication in old patients with chronic diseases，weak constitution，postoperation under the abuse of antibiotics. Clinical symptom were diarrhea, abdominal pain, bloody stool, tenesmus． Endoscopy showed the continuous or diffused presence of pseudomembranes on intestinal mucosa．Conclusion: Antibiotic abusing is the main cause of PMC． The diagnosis can be confirmed by the colonoscopy features simply and reliably，and it would be cured successfully with oral vancomycin, metronidazole and probiotics after withdrawal of antibiotics promptly． [Key words] Pseudrmembranous colitis；Clinical features；Colonscopy; Clinical analysis 伪膜性肠炎（PMC）是一种由难辨梭状芽胞杆菌（clostridium difficile，CD）引起，主要发生在结肠也可累及小肠的急性黏膜坏死、纤维素渗出性炎症，因可在坏死黏膜上形成伪膜而得名，近年来随着抗生素的广泛应用及人口老龄化，PMC患者增多，应引起临床及内镜医师的重视，回顾性分析我院自2005年7月～2011年7月诊断的18例PMC内镜及临床特点如下。 1 资料与方法 1.1 一般资料 本组18例患者中，男11例，女7例，年龄25～85岁，平均61.4岁，其中，60岁以上14例，占77.8%，病例入选符合PMC的诊断标准[1]。 1.2 研究方法 回顾性分析本组患者既往病史、抗生素使用情况、临床表现、结肠镜结果、病理结果、 治疗情况及预后。 ２结果 ２.1 既往病史及抗生素应用情况 本组18例患者中腹部术后感染7例，肺部感染3例，尿毒症3例