葡萄糖酸锌联合蜡样芽孢杆菌活菌片对小儿抗生素相关性腹泻的治疗效果

摘要

目的：探究葡萄糖酸锌联合蜡样芽孢杆菌活菌片对小儿抗生素相关性腹泻的治疗效果。方法选取2013年2月至2015年4月来北京丰台医院就诊的抗生素相关性腹泻患儿112例，依据抽签法随机分为观察组和对照组，各56例。两组均应用蒙脱石散等常规止泻方案进行治疗。对照组在常规治疗方案基础上加用口服葡萄糖酸锌（10 mL／d）；观察组在常规治疗方案的基础上加用口服葡萄糖酸锌（10 mL／d）及蜡样芽孢杆菌活菌片（每次0.25 g，每日3次）。比较两组患儿治疗前后血锌水平、粪检乳杆菌、双歧杆菌水平，白细胞阳性、潜血阳性、脱水率，大便次数、腹泻时间及治疗过程中不良反应（恶心、呕吐及肌肉酸痛）情况。结果治疗24、72 h后，观察组血锌、粪便乳杆菌及双歧杆菌水平呈上升趋势，且各时点血锌、粪便乳杆菌及双歧杆菌水平高于对照组，差异有统计学意义（ P＜0.05）；对照组治疗24 h血锌及治疗24、72 h粪便乳杆菌及双歧杆菌水平下降，差异有统计学意义（P＜0.05）。治疗72 h 观察组白细胞阳性率、潜血阳性率低于对照组[3.6％（2／56）比17.9％（10／56），1.8％（1／56）比14.3％（8／56）]，差异有统计学意义（P＜0.05）；治疗24 h观察组脱水率低于对照组[8.9％（5／56）比25.0％（14／56）]，差异有统计学意义（P＜0.05）。治疗72 h，观察组大便次数少于对照组[（2.9±0.8）次比（3.6±1.1）次]，腹泻时间短于对照组[（3.2±0.8） d 比（5.1±1.7） d]，差异有统计学意义（P＜0.05）。两组患儿恶心、呕吐及肌肉酸痛的发生率比较差异无统计学意义（ P＞0.05）。结论葡萄糖酸锌联合蜡样芽孢杆菌活菌片可明显促进抗生素相关性腹泻患儿肠道正常菌群比例的恢复，改善患儿临床症状，减少腹泻时间及腹泻次数且无明显不良反应。%Objective To explore the effect of treatment of zinc gluconate and Bacillus cereus to the pediatric antibiotic-associated diarrhea.Methods From Feb.2013 to Apr.2015,112 cases of pediatric antibiotic-associated diarrhea in Beijing Fengtai Hospital were included in the study and divided into an observation group and a control group according to the drawing method,56 cases each.Both groups were giv-en montmorillonite and other conventional antidiarrheal program for treatment;and the control group was add-ed with zinc gluconate 10 mL/d per oral on the basic therapy,wile the observation group was added with zinc gluconate 10 mL/d and Bacillus cereus 0.25 g/time,3 times/d per oral on the basic therapy.The blood zinc,stool Lactobacillus, Bifidobacteria,the number of positive white blood cell count,positive occult blood, dehydration rate,stool frequency,duration of diarrhea, were detected before and after treatment.The number of nausea,vomiting and muscle aches were observed and compared.Results At 24, 72 h after treatment,the serum zinc,fecal Lactobacillus and Bifidobacterium levels were rising,andthe serum zinc,fecal Lactobacillus and Bifidobacterium level of the observation group at each different time point were higher than the control group,with statistically significant differences(P <0.05);the serum zinc at 24 h after treatment and fecal Lactobacillus and Bifidobacterium levels of the control group at 24 h, 72 h after treatment dropped,with sta-tistically significant differences(P<0.05).WBC positive rate, occult blood positive rate of the observation group at 72 h after treatment were lower than the control group [ 3.6%( 2/56 ) vs 17.9%( 10/56 ) ,1.8%(1/56) vs 14.3%(8/56)],with statistically significant differences(P<0.05);at 24 h after treatment,the dehydration rate of the observation group was lower than the control group[8.9%(5/56) vs 25.0% (14/56)],the difference was statistically significant(P<0.05).At 72 h after treatment,stool frequency of the observation group was less than the control group[(2.9 ±0.8) times vs (3.6 ±1.1) times],diarrhea time was shorter than the control group[(3.2 ±0.8) d vs (5.1 ±1.7) d],the difference was statistically signifi-cant(P<0.05).The incidence of nausea,vomiting and muscle aches of the two groups was not statistically significantly different(P >0.05).Conclusion Application of zinc gluconate and Bacillus cereus could obviously promote the recovery of normal intestinal flora proportion in children with antibiotic-associated diar-rhea,improve the clinical symptoms and reduce the duration and times of diarrhea without significant adverse reactions.