28例伪膜性肠炎的内镜及临床特点分析

目的探讨伪膜性肠炎(PMC)的诱因、临床表现、结肠镜下特征、诊断及防治。方法对我院2005年5月-2012年5月收治的门诊和住院的共28例PMC患者进行回顾性分析。结果所有患者均出现腹泻,其中11例患者均在使用抗生素过程中出现腹泻;13例患者为老年多病长期服用多种药物致免疫力下降;4例应用糖皮质激素后出现腹痛、腹泻症状。结肠镜检查表现为各段结肠黏膜不同程度地出现充血、水肿及密集点状黄白色微隆起斑块,表面覆有伪膜,其中轻度9例、中度15例、重度4例。所有患者停用抗生素及激素类药物,口服甲硝唑或万古霉素后,均获得治愈或好转。结论伪膜性肠炎常发生在长期应用抗生素、激素及免疫力低下患者,结肠镜检查有助于诊断,早期治疗预后良好。

Analysis of endoscopic and clinical features of 28 pseudomembranous colonitis

Objective To explore the etiology,clinical manifestation,colonoscopic features,diagnosis and treatment of pseudomembranous colonitis(PMC).Methods From May.2005 to May.2012,a total of 28 outpatients and inpatients in our hospital with PMC were retrospectively analyzed.Results All patients appeared diarrhea,11 cases among them appeared diarrhea during the use of antibiotics;13 patients were the senior individuals who long-term took multiple medications with decreased immunology ability;4 patients appeared abdominal pain and diarrhea symptoms after using glucocorticoids.Colonoscopy showed different segment colonic mucosa with different degrees of congestion,edema and densely punctate yellow-white slightly raised plaque,covered with pseudo membrane.9 cases were mild,15 cases were moderate,and 4 cases were severe.All patients accessed to cure or improvement after stopping antibiotics and hormone drugs and took metronidazole or vancomycin.Conclusion Pseudomembranous colonitis often occurs in long-term application of antibiotics,hormone and low immunity patients.Colonoscopy is helpful in the diagnosis and early treatment.The prognosis of PMC is good.