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中华肝脏外科手术学电子杂志 ›› 2025, Vol. 14 ›› Issue (06) : 834 -843. doi: 10.3877/cma.j.issn.2095-3232.2025.06.005

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肠道清洁治疗重症急性胰腺炎研究进展
陆含笑1,2, 吴波1,2, 陈海艳1, 周惠敏1,2, 杨军1,2,†()   
  1. 1　214122　江苏省　无锡市，江南大学附属医院肝胆外科
    2　214122　江苏省　无锡市，江南大学无锡医学院
  • 收稿日期:2025-04-12 出版日期:2025-12-10
  • 通信作者: 杨军
  • 基金资助:
    无锡市科技发展基金(N20201003); 无锡市双百拔尖人才(BJ2023049)

Research progress in bowel cleansing in treatment of severe acute pancreatitis

Hanxiao Lu1,2, Bo Wu1,2, Haiyan Chen1, Huimin Zhou1,2, Jun Yang1,2,†()   

  1. 1 Department of Hepatobiliary Surgery, Affiliated Hospital of Jiangnan University, Wuxi 214122, China
    2 Wuxi School of Medicine of Jiangnan University, Wuxi 214122, China
  • Received:2025-04-12 Published:2025-12-10
  • Corresponding author: Jun Yang
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陆含笑, 吴波, 陈海艳, 周惠敏, 杨军. 肠道清洁治疗重症急性胰腺炎研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(06): 834-843.

Hanxiao Lu, Bo Wu, Haiyan Chen, Huimin Zhou, Jun Yang. Research progress in bowel cleansing in treatment of severe acute pancreatitis[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(06): 834-843.

重症急性胰腺炎（SAP）是消化系统疾病中最危险的腹部急症之一，其特点是发病迅速，并发症严重，病死率高，常导致胰周/胰腺坏死、严重全身炎症反应及多器官衰竭等不良转归，其中胃肠功能衰竭与肠道菌群紊乱更是急性胰腺炎（AP）重症化的关键一环。随着SAP的发病率逐年上升，寻找更多早期有效治疗SAP的途径变得愈加迫切。肠道清洁是SAP的一种有效治疗方法，其主要机制为降低肠道炎症因子水平，减少肠道致病性微生物，限制肠道菌群的移位并提高益生菌的丰度维持菌群平衡，保护肠屏障功能的完整性，进一步减少全身炎症反应综合征等并发症发生，从而起到阻断SAP发生发展，改善SAP预后的作用。本文就肠道清洁改善肠道功能治疗SAP的研究进展进行探讨。

关键词: 重症急性胰腺炎, 肠道清洁, 肠道功能, 菌群紊乱

Severe acute pancreatitis (SAP) is one of the most dangerous abdominal emergencies in digestive system diseases, characterized by rapid onset, serious complications and high mortality rate. SAP constantly leads to peripancreatic/pancreatic necrosis, severe systemic inflammatory response and multiple organ failure, among which gastrointestinal failure and intestinal flora disorder are the key links during the aggravation of acute pancreatitis (AP). With the increasing incidence of SAP year by year, it becomes urgent to identify more effective treatment for early-stage SAP. Intestinal cleansing is an effective treatment for SAP. The main mechanisms include reducing the levels of intestinal inflammatory cytokines, decreasing gut pathogenic microorganisms, limiting the displacement of intestinal flora, increasing the abundance of probiotics to maintain flora balance, protecting the integrity of intestinal barrier function, and further lowering the occurrence of complications such as systemic inflammatory response syndrome, thereby preventing the incidence and progression of SAP and improving clinical prognosis. In this article, research progress in intestinal cleansing for improving intestinal function and treating SAP was illustrated.

Key words: Severe acute pancreatitis, Bowel cleansing, Intestinal function, Dysbacteriosis
图1 SAP发病环节中胰腺和肠道及全身性疾病相互影响示意图
表1 临床上常用导泻药物种类及作用机制
药物种类 主要药物 作用机制 优点 缺点
容积性泻药（渗透性泻药） 硫酸镁、乳果糖、硫酸钠、甲基纤维素、聚乙二醇4 000散 口服后肠道很少吸收, 增加肠容积, 促进肠道推动性蠕动 较少引起腹部不适, 乳酸还可抑制结肠对氨的吸收, 以防治肝性脑病 过量易口渴、腹痛, 常需同时服用大量水
接触性泻药（刺激性泻药） 蒽醌类（大黄、番泻叶、芦荟）二苯甲烷类（酚酞、比沙可啶） 刺激结肠推动性蠕动 有效清洁肠道, 广泛用于术前准备和结肠镜检查前清肠 大黄植物中含有鞣酸, 可引起继发便秘；酚酞偶导致过敏
润滑性泻药 液状石蜡、甘油 局部润滑、软化粪便 起效迅速, 短期使用不影响营养物质的吸收 孕妇应注意新生儿出血性疾病；易导致消化道溃疡不愈
图2 SAP早期肠道清洁药物及其对胰腺和肠道的影响 注：SAP为重症急性胰腺炎
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