小儿腹泻病 湖南省儿童医院消化科 游洁玉 一、概念 腹泻病（diarrheal disease）是由多病 原、多因素引起的一组疾病，主要是有大便 性状改变与大便次数比平时增多，在未明确 病因前，统称为腹泻病，是我国婴幼儿最常 见的消化道综合征。6个月2岁婴幼儿发病 率高，1岁以内约占半数，是造成小儿营养不 良、生长发育障碍和死亡的主要原因之一。 1982年，石家庄会议把腹泻病分为感染性与 非感染性腹泻. Definition diarrheal disease is a group of diseases caused by multiple pathogens,mainly defined as an increase in the frequency and the water content of stools. Diarrhea is the most common gastrointestinal syndrome of infants in our country. For 6 months to 2 years old infants the incidence rate is high, 1 year old infants accounted for about 50%,Diarrhea is one of the main cause of infant malnutrition, growth retardation and death. In 1982, the Shijiazhuang conference classified the diarrheal disease into infectious and non infectious diarrhea. 二、病程分类classification 1、急性腹泻病（acute diarrheal disease）： 病程在2周以内 (within 2 weeks) 2、迁延性腹泻病(persistent diarrheal disease) ： 病程在2周-2个月 (2 weeks-2 months) 3、慢性腹泻(chronic diarrheal disease)： 病程在2个月以上。 (over 2 weeks) classification 1、感染性腹泻：infectious diarrhea. 痢疾、霍乱、其他感染性腹泻. Dysentery, cholera, and other infectious diarrhea. 2、非感染性腹泻：non infectious diarrhea. 食饵性（饮食性）腹泻病 症状性腹泻病 过敏性腹泻病等. allergic diarrhea. 四、流行病学epidemiology 小儿腹泻病为第三世界国家小儿第一 位常见多发病，死因在我国居第二位。 1986年对广东等七省妇糼卫生示范县及北 京市的流行病学调查，发现5岁以下小儿 急性腹泻年发病率为201.46%，平均年发 病次数为2.010.03次/人，平均死亡率 为0.51。1988年21省入户调查发现5岁 以下小儿发病率为每年0.86-3.9次/人， 平均为每年2.5次/人。 Infantile diarrhea is the most common desease in third world countries,and is the second causes causing death in China. In 1986, seven provinces,including Guangdong province, made an epidemiological investigation, found that children ,under 5 years old,the annual incidence rate of the acute diarrhea was 201.46%, the average annual incidence rate is 2.010.03 / person, the average mortality rate was 0.51 per thousand. In 1988, investigation found that children under 5 years old the incidence rates was about 0.86-3.9 times/ person, an average rate of 2.5 times per year / person. 发病两个高峰期。 夏季腹泻：发生于6、7、8月，主要是致病性大肠 杆 菌与痢疾杆菌， 秋季腹泻：发生于10、11、12月，为，主要致病菌 为 轮状病毒， 危险因素：1岁以内婴儿；小儿照看人卫生差 ； 小儿饭前不用肥皂洗手； 既往经常患腹泻病；饮用水不洁； 禽畜放养。 Summer diarrhea: peak incidence is in June,July, August, the main pathogens are pathogenic Escherichia coli and Bacteria associated with Shigella. Autumn diarrhea: peak incidence is in October,November, December, the main pathogen is Rotavirus. Risk factors : 1. infants under the age of 1 year; 2.poor health of baby sitter; 3.The children dont have the habit washing hands before meals; 4.Have a history of diarrhea disease; 5.the drinking water is unclean; 6.Livestock grazing Predisposing factors 1、婴幼儿消化系统发育尚未成熟：胃酸和消化酶分泌 少，酶活力偏低；生长发育快，所需营养物质相对较多 ，胃肠道负担重，进入量较多，加重了胃肠道的负担； 婴幼儿水分代谢旺盛，对缺水的耐受力差，易发生体液 紊乱；婴儿时期神经、内分泌、循环、肝、肾功能发育 不成熟，容易发生消化道功能紊乱。 Infants digestive system development is not yet mature: the gastric acid and digestive enzymes secreted less than the adult, enzyme activity is poor,but the growth velosity is rapid, it needs relatively more nutrients, so the burden of the gastrointestinal function is a heavy,the more the infant eat,the more burdun it exists; As the nerve, endocrine, circulatory, liver, renal function are immature in infants, prone to have gastrointestinal dysfunction. Predisposing factors 2、机体防御功能差：婴儿胃酸偏低，胃排空较快，对进人胃内 的细菌杀灭能力较弱；血清免疫球蛋白（尤其是 lgM、lgA）和 胃肠道分泌型 IgA均较低;新生儿生后尚未建立正常肠道菌群时， 或由于使用抗生素等引起肠道菌群失调时，均易患肠道感染。 2.infants defence function is poor: the ability of killing of intragastric bacterial is poor. the secretion of serum globulin ( especially lgM, lgA ) and gastrointestinal IgA Is poor too. the Newborns normal intestinal flora has not been established, or the imbalance of intestinal flora caused by the abuse of antibiotics, are susceptible to enteric infection. Predisposing factors 3、人工喂养： 家畜乳中虽有母乳中某些成分，但在加热 过程中被破坏，而且人工喂养的食物和食具极易受污染 ，故人工喂养儿肠道感染发生率明显高于母乳喂养儿 Livestock milk has some ingredients of human milk, but it can be destroyed in the process of heating, and artificial feeding food and tableware are too easy to be polluted, so the artificial feeding infants has the significant higher intestinal infection rate compare to the breast-fed infants. 六、感染因素Infectious factors 1、 肠道内感染：由病毒、细菌、真菌、寄生虫引起，以前两者多见，尤其是 病毒。 2、肠道外感染：如患中耳炎、上呼吸道感染、肺炎、肾盂肾炎、皮肤感染或 急性传染病时，可由于发热、感染原释放的毒素、抗生素治疗、直肠局部 激惹（膀胱感染）作用而并发腹泻。有时病原体（主要是病毒）可同时感 染肠道。 3、滥用抗生素引起的肠道菌群紊乱。 Intestinal infection: virus, bacteria, fungi, parasite can cause diarhea, the former two are the most common reasons, especially the virus. Other infection: when suffering from otitis media, upper respiratory tract infection, pneumonia, pyelonephritis, skin infection or acute infectious diseases, patients may appear diarrhea for reasons of fever, infection, antibiotic therapy, the toxins released partial rectal bowel ( bladder infection ). Sometimes the pathogen (mainly virus ) in the same time cause the gut infection. The abuse abuse of antibiotics causes intestinal flora disturbance. 七、非感染因素none infectious factors 1、饮食因素 Dietary factors 1）喂养不当：多为人工喂养儿，原因为：喂养不定时；饮食量