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什么是小儿细菌性痢疾?如何治疗?

发布日期:2024-09-05 18:35:06编辑:胖虎爱撩妹

细菌性痢疾简称菌痢,是由志贺菌属引起的常见肠道传染病。各年龄组小儿均易感,多见于3岁以上儿童。全年均可发病,多流行于夏秋季节。本病可分为:急性菌痢、非典型菌痢、慢性菌痢及中毒性痢疾,其中中毒性菌痢病情经过极为凶险,起病急骤,突发高热、惊厥或休克,如抢救不当,可迅速发生呼吸或循环衰竭而死亡。
 
一、小儿细菌性痢疾的病因
 
病原是痢疾杆菌,属于肠杆菌的志贺菌属,分A、B、C、D四群(志贺菌、福氏菌、鲍氏菌、宋内氏菌),我国以福氏志贺菌多见。志贺菌属经口进入胃肠道,侵入结肠上皮细胞,并生长繁殖,细菌裂解后产生大量内毒素与少量外毒素,志贺菌内毒素从肠壁吸收入血后,引起发热、毒血症及急性微循环障碍。
 
二、本病有何表现?
 
1.急性细菌性痢疾:典型病例,起病急,发热、腹泻、大便性状为脓血便或黏液便,伴有阵发性腹痛、里急后重,有时有热性惊厥,腹部可有轻压痛,可触及痉挛性乙状结肠,肠鸣音亢进。
 
2.非典型菌痢:不发热或只有微热,也无中毒症状,轻度腹泻,粪便内只有黏液而无脓血,只有大便培养阳性才能确诊。
 
3.慢性菌痢:急性菌痢病程超过2周称为迁延性痢疾,超过2个月则为慢性菌痢。急性菌痢未得到合理治疗,或发生于有营养不良、佝偻病或贫血小儿。
 
4.中毒性痢疾:是菌痢的一种严重类型,起病急骤,病情凶险,高热可达39℃~40℃或更高,伴全身中毒症状,如治疗不及时可很快发展为呼吸循环衰竭而死亡。
 
(1)脑型(脑微循环障碍型):以脑水肿为主要表现,出现精神萎靡、嗜睡、惊厥等,严重时可出现昏迷、频繁或持续抽搐、瞳孔不等大、对光反射迟钝或消失,甚至中枢性呼吸衰竭(呼吸深浅不匀、节律不整、甚至呼吸停止),此型较严重,病死率高。
 
(2)休克型(皮肤内脏微循环障碍型):表现为感染中毒性休克,患儿烦躁、精神萎靡、面色苍白、末梢循环差、四肢厥冷、脉细速、血压下降、少尿或无尿。
 
(3)肺型(肺微循环障碍型):又称呼吸窘迫综合征,以肺微循环障碍为主。表现为烦躁不安、呼吸加快、进行性呼吸困难。严重时胸部X线可见肺部大片状阴影或广泛实变,血气分析表现为低氧血症和高CO2血症。
 
(4)混合型:上述2型或3型同时存在或先后出现。由于全身严重的微循环障碍,组织缺氧缺血严重,极易发生器官功能衰竭,病死率极高。
 
严重病例常合并DIC,肾功能衰竭,偶可合并溶血尿毒综合征。
 
三、如何治疗小儿细菌性痢疾?
 
1.急性细菌性痢疾
 
(1)一般治疗:隔离、卧床休息、半流质易消化饮食。
 
(2)支持和对症治疗:退热、止吐以及止痉药缓解腹痛等,另外应该按脱水程度给予液体疗法。
 
(3)抗菌治疗:最好根据药敏试验选用抗生素,可选用阿米卡星、第三代头孢菌素、含酶抑制剂的第三代头孢菌素或碳青霉烯类等药物。
 
2.中毒性菌痢
 
(1)降温止惊:可综合使用物理、药物降温或亚冬眠疗法。惊厥不止者,可用地西泮肌内注射或静脉注射;或用水合氯醛保留灌肠;或肌注苯巴比妥钠。    
 
(2)抗休克治疗:扩充血容量,纠正酸中毒,维持水与电解质平衡,改善微循环。
 
(3)防治脑水肿和呼吸衰竭:保持呼吸道通畅,给氧。首选20%甘露醇降颅压,或与利尿剂交替使用,可短期静脉推注地塞米松,剂量同上。若出现呼吸衰竭应及早使用呼吸机。
 
(4)抗菌治疗同急性细菌性痢疾。
 
3.慢性菌痢
 
(1)一般治疗:适当休息,生活规律,避免过饥过饱,以少渣易消化的食物为主。
 
(2)抗菌治疗:选用药物见急性细菌性痢疾,采用间歇疗法,即用药7天,停4天,再用4天,停4天,再用4天,总疗程23天。若大便次数不多,但性质不正常者,有黏液脓血便,或细菌培养阳性,可选用中西药保留灌肠。
 
(3)对症、支持治疗:如补充多种维生素、纠正营养不良性贫血等。
 
(4)微生态疗法:双歧杆菌制剂等。
 
(5)肠黏膜保护剂:如蒙脱石散、谷氨酰胺等。
 
四、如何预防小儿细菌性痢疾?
 
做好个人卫生,喝开水不喝生水,用消毒过的水洗瓜果蔬菜和碗筷及漱口;饭前便后要洗手,不要随地大便;剩饭菜要加热后吃;做到生熟分开,防止苍蝇叮爬食物;得病后要及时治疗。
 
注意:痢疾杆菌最适宜生长温度为37℃,在水果、蔬菜中能生存10天,牛奶中能生存24天,不耐热,加热60℃10分钟即可灭活。
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