儿童沙门菌肠炎临床用药疗效比较剖析.docVIP

儿童沙门菌肠炎临床用药疗效比较剖析 　　摘 要：目的 ?结近两年内我科沙门菌临床特征，回顾性分析比较141例沙门菌肠炎用药疗效，以提高临床治愈率。方法 141例沙门菌肠炎根据大便培养药敏结果分为对β-内酰胺类抗生素敏感组和耐药组，比较两组间平均住院日统计学差异，并根据选择不同抗菌药进行疗效对比。结果 本文中沙门菌属对β-内酰胺类抗生素耐药率高达23.40%；耐药菌组较敏感菌组平均住院日稍长（P0.05）；敏感菌组内头孢呋辛疗效差，与头孢曲松、头孢哌酮他唑巴坦钠和头孢他啶疗效相比，差异有统计学意义（P0.05），头孢三代抗菌药疗效相比较差异无统计学意义；耐药菌组中口服复方新诺明片和庆大霉素片总有效率高，头孢哌酮钠他唑巴坦钠在头孢组中总有效率最高。结论 细菌性肠炎应尽早行大便培养明确致病菌，并获得药物敏感信息指导临床用药；沙门菌属β-内酰胺类抗生素敏感菌，首选三代头孢，β-内酰胺类抗生素耐药菌可选用带酶抑制剂的三代头孢，或根据药物敏感结果选用口服复方新诺明片和庆大霉素片。 　　关键词：沙门菌肠炎；β-内酰胺类抗生素；腹泻 　　中图分类号：R725.1 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.01.049 　　文章编号：1006-1959（2018）01-0127-04 　　Comparative Analysis of Clinical Efficacy of Salmonella Enteritis in Children 　　HUANG Qi-yun1，CHEN Gui-ling2，TANG Yao-guang3，ZENG Li-ping4 　　（Department of Pediatrics1，Microorganism Room2，Laboratory3，Statistics Room4，Dongguan Tung Wah Hospital，Zhongshan University， Dongguan 523000，Guangdong，China） 　　Abstract：Objective To summarize the clinical features of Salmonella in our hospital in recent two years，and retrospectively analyze and compare the efficacy of Salmonella enteritidis in 141 cases to improve the clinical cure rate.Methods 141 cases of Salmonella enteritidis were divided into β-lactam antibiotic sensitive group and drug-resistant group according to the sensitization results of stool culture.The average length of stay between the two groups was compared，and the curative effect was compared according to different antibacterials.Results In this paper，the resistant rate of Salmonella to β-lactam antibiotics was as high as 23.40%；the average length of stay in drug-resistant bacteria group was slightly longer（P 　　Key words：Salmonella enteritis；β-lactam antibiotics；Diarrhea 　　沙门菌属种类繁多，目前国际上已发现2300多个血清型，我国有255个，其中引起疾病的主要有鼠伤寒沙门菌、猪霍乱沙门菌、肠炎沙门菌等。沙门菌进入肠道后大量繁殖，除使肠粘膜发炎外，大量活菌释放的内毒素同时引起机体中毒。鼠伤寒沙门菌小肠结肠炎占沙门菌感染的40%～80%，全年均有发生，夏季发病率高，绝大多数患儿为2岁的婴幼儿，新生儿和1岁婴儿尤易感染，常引起暴发流行。临床表现轻重不一，发病较急，有恶心、呕吐、腹痛、腹泻、腹胀、发热；大便每天数次至数十次，稀糊状、带有粘液甚至脓血，性质多变，有特殊臭味；镜检有红、白细胞和脓细胞。严重者可出现脱水、酸中毒、全身中毒症状，甚至发生休克；亦可引起败血症、脑脊髓膜炎。病程迁延，有并发症者可长达数周。带菌率高，部分患