布拉氏酵母菌在预防婴幼儿抗生素相关性腹泻中的临床研究

发布时间：2018-01-04 12:38

本文关键词：布拉氏酵母菌在预防婴幼儿抗生素相关性腹泻中的临床研究　出处：《郑州大学》2013年硕士论文　论文类型：学位论文

【摘要】：背景与目的抗生素相关性腹泻(antibiotic-associated diarrhea, AAD)是指应用抗生素后发生的、与抗生素有关的且没有其它原因可以解释的腹泻,也包括抗生素本身的不良反应所导致的腹泻,它是发生在抗生素治疗48h后,连续24h之内出现3次以上水样便、粘液便或不成形便。Bartlett对AAD的解释是：在抗生素使用过程中或使用之后出现的腹泻,并排除细菌性痢疾、轮状病毒性肠炎等疾病,但是又找不到引起腹泻的原因。近年来,广谱抗生素在儿科中应用越来越多,由此引发的抗生素相关性腹泻也在逐年上升,接受广谱抗生素治疗的儿童,AAD的发生率在11%～40%之间,80%以上发生在抗生素应用4～5天时。任何抗生素都可以引起AAD的发生,典型发生率为5%～35%,它是最常见的医源性腹泻。抗菌药物为目前住院患儿应用最普遍的药物之一,虽然挽救了无数感染者的生命,但也产生了一系列不容忽视的问题,其常见的副反应中AAD受到越来越多的重视。AAD的发生机制：①肠道菌群失调；②抗生素干扰糖和胆汁酸代谢；③抗生素的变态反应及毒性作用对肠黏膜的直接作用；④药理学作用对肠道动力的改变。益生菌具有抗菌活性和抗毒素作用,其机理是：促进肠道正常菌群平衡、直接抑制病原菌生长、分泌抗致病菌毒素蛋白和增强肠道免疫屏障功能,从而减少腹泻天数、减轻脱水程度[6]。经国外临床研究证实布拉氏酵母菌(Saccharomyces boulardii, SB)可有效预防儿童AAD的发生,但是国内有关SB预防儿童AAD方面的研究报告还不多。SB是目前全球唯一的生理性真菌制剂,它不会被胃液、胆盐、胰蛋白酶、糜蛋白酶等消化酶所灭活,口服时无需与抗生素间隔时间。它具有促进肠道正常菌群平衡、抗菌活性、抗毒素作用、营养作用等独特的作用机制。最近文献的一项荟萃分析显示,SB可成为临床医生控制小儿罹患腹泻的有效手段之一,可缩短腹泻病程及住院时间。笔者选取在我科应用抗生素治疗的肺炎患儿98例作为观察组,收集2007年-2009年肺炎患儿病历92例作为对照组,对其临床资料进行回顾性分析,以探讨SB在婴幼儿抗生素相关性腹泻中的预防作用,并提高临床儿科医师对其的认识。资料与方法 1研究对象的选取观察组为收集2011年10月～2013年1月在我科住院治疗的肺炎患儿98例,其中男48例,女50例,年龄1月～3岁,1月～1岁71例,1岁～3岁27例,均为足月儿,出生时情况均无异常,接受抗生素治疗≥7天,抗生素种类均为头孢菌素类,静脉给药。排除：入选时存在腹泻或入院后48h内出现腹泻者；长期接受免疫抑制剂治疗者；有先天畸形者；病情危重者；需要消化道手术者；患有心血管系统及血液系统疾病者；入选前2周内接受过益生菌制剂治疗者；确诊毛细支气管炎者；确诊轮状病毒性肠炎者；接受具有腹泻副作用的中成药的治疗者。对照组92例(2007年～2009年),患儿在肺炎治疗过程中未使用过任何微生态制剂。两组患儿在性别、年龄、肺炎常规治疗以及对患儿的病情评估上,差异无统计学意义,具有可比性。 2研究对象的分组处理观察组在抗感染及对症支持治疗基础上,入选时即加服布拉氏酵母菌散剂,对照组仅给予抗感染及对症支持治疗,比较两组腹泻的发生率、腹泻的严重程度以及腹泻持续时间。 3统计学分析使用SPSS17.0统计软件对观察数据资料进行分析,两组AAD的发生率、腹泻程度以及治疗效果的比较采用x2检验,腹泻持续天数的比较采用t检验,检验水准为P=0.05,P0.05表示差异具有统计学意义。结果观察7天内观察组98例出现AAD22例,发生率22.45%,出现重度腹泻6例,发生率6.12%,腹泻持续时间(2.89±0.63)d；对照组92例出现AAD28例,发生率为30.43%,出现重度腹泻8例,发生率8.70%,腹泻持续时间(4.38±0.71)d。两组腹泻持续时间比较差异有统计学意义(t=5.39,P0.01) 结论布拉氏酵母菌散剂能有效降低肺炎患儿AAD的发生率,缩短腹泻持续时间以及减轻腹泻程度,利于患儿病情恢复,值得临床推广使用。
[Abstract]:Background and purpose
Antibiotic associated diarrhea (antibiotic-associated diarrhea, AAD) is refers to the use of antibiotics, antibiotic related and no other reason can explain the diarrhea, also caused the adverse reactions of antibiotics itself diarrhea, it occurs in the antibiotic treatment after 48h, 24h within the continuous emergence of more than 3 mucous or watery stool. No.Bartlett of AAD forming explanation is: after the use of antibiotics or used during diarrhea, and eliminate bacterial dysentery, rotavirus enteritis and other diseases, but also can not find the cause of diarrhea. In recent years, more and more application of broad-spectrum antibiotics in pediatrics, antibiotic associated diarrhea caused by is rising year by year, received broad-spectrum antibiotics for children, the incidence of AAD in 11% to 40%, more than 80% occurred in 4 ~ 5 days of antibiotic application. Any antibiotic It can cause the occurrence of AAD, the typical incidence of 5% to 35%, it is the most common iatrogenic diarrhea.
Antimicrobial agents for the hospital is one of the most widely used drugs in children, although saved the lives of countless people, but also produced a series of problems can not be ignored, the common adverse reactions in the pathogenesis of AAD is more and more attention to.AAD: the imbalance of intestinal flora; the antibiotics interfere with sugar and bile acid metabolism direct action; allergic reaction and toxic effects of antibiotics on intestinal mucosa; change the pharmacological effects on intestinal motility. Probiotics has antibacterial and anti toxin activity, its mechanism is to promote the balance of intestinal microflora, directly inhibit pathogen growth, secretion of anti pathogenic toxin protein and enhance the intestinal immune barrier function. In order to reduce diarrhea days, reduce the degree of dehydration of [6]. by clinical study abroad confirmed (Saccharomyces boulardii, SB) can effectively prevent the occurrence of AAD in children, but Is the domestic research report on SB prevention of childhood AAD is not more than.SB is currently the world's only physiological fungal agents, it will not be gastric juice, bile salts, trypsin, chymotrypsin and other digestive enzymes are inactivated, and without oral antibiotics. It can promote the normal intestinal flora balance, antibacterial the activity of anti toxin effect, mechanism of nutritional role is unique. A recent meta-analysis of the literature shows that SB can be one of the effective means to control the clinicians of children suffering from diarrhea, diarrhea can shorten the course of disease and hospitalization time.
The author selected in our department to antibiotic treatment in children with pneumonia and 98 cases as the observation group, collected in 2007 -2009 pneumonia records in 92 cases as control group, and the clinical data were retrospectively analyzed to explore the SB in infantile antibiotic associated diarrhea in prevention, and to improve the understanding of the clinical pediatrician.
Information and methods
1 Selection of research objects
The observation group was collected from October 2011 to January 2013 in our hospital 98 cases of pneumonia were treated, including 48 cases of male, female 50 cases, age from January to 3, January to 1 years in 71 cases, aged 1 to 3 years old in 27 cases, all full-term birth, are no exception, received 7 days of antibiotics treatment of aged, antibiotics were cephalosporins, intravenous drug. Excluded: diarrhea or diarrhea within 48h after admission are selected; receive long-term immunosuppressive therapy; congenital malformation; critical condition; need gastrointestinal surgery; cardiovascular system and blood system diseases; selected 2 weeks ago received probiotics in the treatment of bronchiolitis; diagnosis; diagnosis of rotavirus enteritis; acceptance of Chinese patent medicines have side effects in the treatment of diarrhea. 92 cases of the control group (2007 to 2009), had not used in children pneumonia during treatment There was no statistically significant difference in sex, age, routine treatment of pneumonia and the assessment of the condition of the children in the two groups.
2 group processing of research objects
In the observation group, anti infection and symptomatic support treatment on the basis of the selected given boulardii, the control group only received anti infection and symptomatic treatment, compared between the two groups the incidence of diarrhea, diarrhea severity and duration of diarrhea.
3 statistical analysis
SPSS17.0 statistical software was used to analyze the observed data. Two groups of AAD incidence, diarrhea degree and treatment effect were compared by x2 test. Compared with the days of diarrhea, t test was used, the test level was P=0.05, P0.05 showed the difference was statistically significant.
Result
Observed within 7 days of the observation group occurred in 98 cases of AAD22 patients, the incidence was 22.45%, severe diarrhea in 6 cases, the incidence rate was 6.12%, the duration of diarrhea (2.89 + 0.63) d; the control group of 92 cases of AAD28 patients, the incidence rate was 30.43%, severe diarrhea in 8 cases, the incidence rate was 8.70%, the duration of diarrhea (4.38 two + 0.71) d. group diarrhea duration difference was statistically significant (t=5.39, P0.01)
conclusion
Boulardii can effectively reduce the incidence of AAD pneumonia, shorten the duration of diarrhea and reduce the degree of diarrhea in children with the disease, conducive to recovery, is worthy of clinical use.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R725.7

【参考文献】