儿童急性重症溃疡性结肠炎的优化治疗

Optimal management of acute severe ulcerative colitis in children

急性重症溃疡性结肠炎(ASUC)是儿童消化科急重症之一,病情凶险,严重者可危及患儿生命。严密监测和及时的药物与手术干预是改善预后的关键措施。治疗包括提供必要的营养支持、纠正水电解质紊乱、排除可能合并的细菌或病毒感染,高危患儿需要皮下注射低分子肝素预防血栓形成。静脉应用糖皮质激素为ASUC的一线治疗,对于糖皮质激素治疗3~5 d症状无改善者,需要应用免疫抑制剂或生物制剂进行二线挽救治疗,并密切监测患儿临床症状、血清炎症指标和白蛋白水平等。对于药物治疗失败者,需及时行结肠切除术,以防止严重并发症的发生。现通过回顾文献和专家共识、指南,总结儿童ASUC的临床评估和疾病不同阶段的治疗方法,旨在规范儿童ASUC的临床治疗。

Acute severe ulcerative colitis(ASUC)is one emergency in pediatric gastroenterology.The disease is serious,which may even endanger the life of patients.Close monitoring and timely pharmacological and surgical interventions are key measures to improve outcomes.Treatment methods for ASUC include necessary nutritional support,water and electrolyte disturbance correction,and possible concurrent bacterial or viral infection elimination.Patients at high risk require subcutaneous injections of low molecular weight heparin to prevent thrombosis.Intravenous cortico-steroids are the first-line treatment of ASUC.For patients showing insufficient response to corticosteroids after 3-5 days,rescue treatment with immunosuppressants or biological agents is needed.Meanwhile,the clinical symptoms,serum inflammatory indicators and albumin levels of the patients should be closely monitored.Patients who failed medical treatment should undergo timely colectomy to prevent serious complications.In this paper,a systematic review of literature and expert consensus was conducted to summarize the clinical evaluation and treatment methods of ASUC children at different stages,in order to standardize the clinical treatment of pediatric ASUC.