本文關(guān)鍵詞：布拉氏酵母菌在預(yù)防嬰幼兒抗生素相關(guān)性腹瀉中的臨床研究　出處：《鄭州大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

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【摘要】：背景與目的 抗生素相關(guān)性腹瀉(antibiotic-associated diarrhea, AAD)是指應(yīng)用抗生素后發(fā)生的、與抗生素有關(guān)的且沒有其它原因可以解釋的腹瀉,也包括抗生素本身的不良反應(yīng)所導(dǎo)致的腹瀉,它是發(fā)生在抗生素治療48h后,連續(xù)24h之內(nèi)出現(xiàn)3次以上水樣便、粘液便或不成形便。Bartlett對AAD的解釋是：在抗生素使用過程中或使用之后出現(xiàn)的腹瀉,并排除細(xì)菌性痢疾、輪狀病毒性腸炎等疾病,但是又找不到引起腹瀉的原因。近年來,廣譜抗生素在兒科中應(yīng)用越來越多,由此引發(fā)的抗生素相關(guān)性腹瀉也在逐年上升,接受廣譜抗生素治療的兒童,AAD的發(fā)生率在11%～40%之間,80%以上發(fā)生在抗生素應(yīng)用4～5天時(shí)。任何抗生素都可以引起AAD的發(fā)生,典型發(fā)生率為5%～35%,它是最常見的醫(yī)源性腹瀉。 抗菌藥物為目前住院患兒應(yīng)用最普遍的藥物之一,雖然挽救了無數(shù)感染者的生命,但也產(chǎn)生了一系列不容忽視的問題,其常見的副反應(yīng)中AAD受到越來越多的重視。AAD的發(fā)生機(jī)制：①腸道菌群失調(diào)；②抗生素干擾糖和膽汁酸代謝；③抗生素的變態(tài)反應(yīng)及毒性作用對腸黏膜的直接作用；④藥理學(xué)作用對腸道動(dòng)力的改變。益生菌具有抗菌活性和抗毒素作用,其機(jī)理是：促進(jìn)腸道正常菌群平衡、直接抑制病原菌生長、分泌抗致病菌毒素蛋白和增強(qiáng)腸道免疫屏障功能,從而減少腹瀉天數(shù)、減輕脫水程度[6]。經(jīng)國外臨床研究證實(shí)布拉氏酵母菌(Saccharomyces boulardii, SB)可有效預(yù)防兒童AAD的發(fā)生,但是國內(nèi)有關(guān)SB預(yù)防兒童AAD方面的研究報(bào)告還不多。SB是目前全球唯一的生理性真菌制劑,它不會(huì)被胃液、膽鹽、胰蛋白酶、糜蛋白酶等消化酶所滅活,口服時(shí)無需與抗生素間隔時(shí)間。它具有促進(jìn)腸道正常菌群平衡、抗菌活性、抗毒素作用、營養(yǎng)作用等獨(dú)特的作用機(jī)制。最近文獻(xiàn)的一項(xiàng)薈萃分析顯示,SB可成為臨床醫(yī)生控制小兒罹患腹瀉的有效手段之一,可縮短腹瀉病程及住院時(shí)間。 筆者選取在我科應(yīng)用抗生素治療的肺炎患兒98例作為觀察組,收集2007年-2009年肺炎患兒病歷92例作為對照組,對其臨床資料進(jìn)行回顧性分析,以探討SB在嬰幼兒抗生素相關(guān)性腹瀉中的預(yù)防作用,并提高臨床兒科醫(yī)師對其的認(rèn)識。 資料與方法 1研究對象的選取 觀察組為收集2011年10月～2013年1月在我科住院治療的肺炎患兒98例,其中男48例,女50例,年齡1月～3歲,1月～1歲71例,1歲～3歲27例,均為足月兒,出生時(shí)情況均無異常,接受抗生素治療≥7天,抗生素種類均為頭孢菌素類,靜脈給藥。排除：入選時(shí)存在腹瀉或入院后48h內(nèi)出現(xiàn)腹瀉者；長期接受免疫抑制劑治療者；有先天畸形者；病情危重者；需要消化道手術(shù)者；患有心血管系統(tǒng)及血液系統(tǒng)疾病者；入選前2周內(nèi)接受過益生菌制劑治療者；確診毛細(xì)支氣管炎者；確診輪狀病毒性腸炎者；接受具有腹瀉副作用的中成藥的治療者。對照組92例(2007年～2009年),患兒在肺炎治療過程中未使用過任何微生態(tài)制劑。兩組患兒在性別、年齡、肺炎常規(guī)治療以及對患兒的病情評估上,差異無統(tǒng)計(jì)學(xué)意義,具有可比性。 2研究對象的分組處理 觀察組在抗感染及對癥支持治療基礎(chǔ)上,入選時(shí)即加服布拉氏酵母菌散劑,對照組僅給予抗感染及對癥支持治療,比較兩組腹瀉的發(fā)生率、腹瀉的嚴(yán)重程度以及腹瀉持續(xù)時(shí)間。 3統(tǒng)計(jì)學(xué)分析 使用SPSS17.0統(tǒng)計(jì)軟件對觀察數(shù)據(jù)資料進(jìn)行分析,兩組AAD的發(fā)生率、腹瀉程度以及治療效果的比較采用x2檢驗(yàn),腹瀉持續(xù)天數(shù)的比較采用t檢驗(yàn),檢驗(yàn)水準(zhǔn)為P=0.05,P0.05表示差異具有統(tǒng)計(jì)學(xué)意義。 結(jié)果 觀察7天內(nèi)觀察組98例出現(xiàn)AAD22例,發(fā)生率22.45%,出現(xiàn)重度腹瀉6例,發(fā)生率6.12%,腹瀉持續(xù)時(shí)間(2.89±0.63)d；對照組92例出現(xiàn)AAD28例,發(fā)生率為30.43%,出現(xiàn)重度腹瀉8例,發(fā)生率8.70%,腹瀉持續(xù)時(shí)間(4.38±0.71)d。兩組腹瀉持續(xù)時(shí)間比較差異有統(tǒng)計(jì)學(xué)意義(t=5.39,P0.01) 結(jié)論 布拉氏酵母菌散劑能有效降低肺炎患兒AAD的發(fā)生率,縮短腹瀉持續(xù)時(shí)間以及減輕腹瀉程度,利于患兒病情恢復(fù),值得臨床推廣使用。
[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.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R725.7

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