全方位抗击宝宝的慢性腹泻
当宝宝腹泻超过2个月以上就可以称为慢性腹泻。由于腹泻迁延不愈，常伴有消化吸收障碍、营养不良、反复感染和生长发育落后，严重危害了小儿身心健康。
宝宝慢性腹泻的原因有种种
1.对糖的不耐受：宝宝对糖不耐受腹泻最多见是双糖酶缺乏或活力减低所致。原发性双糖不耐受在出生后不久即有腹泻，原因是缺少双糖酶使大量糖不能吸收，在肠道内形成渗透压增高，使大量水分吸收到肠腔中，形成腹泻。继发性双糖不耐受更多见，是由于胃肠炎后肠粘膜受损，致使双糖酶缺乏。这种腹泻可持续数月。
2.对牛奶过敏：牛奶 是一种异性蛋白，其中一种乳球蛋白会损害小肠粘膜，是主要的过敏原。如小婴儿对致敏的牛奶蛋白清除及处理功能较差，就会发生腹泻和腹痛。此时不停牛奶，腹泻就迁延不愈。
3.菌群失调：当宝宝患了严重的感染性疾病或手术后抵抗力明显下降，若在此时应用大量广谱抗菌素或皮质激素治疗，使小儿免疫功能低下，对抗菌素敏感的肠道内正常细菌受到抑制，而不敏感的致病菌就会大量繁殖引起长久的腹泻。
4.对麦类过敏：患儿对大麦、小麦和黑麦中麸质(麦粉中的蛋白质)的抗原部分过敏，引起局部肠道过敏反应。当脂肪进入小肠后不易被肠壁吸收，遂从粪便中排出，造成持久的脂肪泻。
5.营养不良：容易使腹泻迁延不愈，持久的腹泻又促进营养不良，这样互为因果，形成恶性循环。
6.人工喂养：人工喂养儿免疫力低，失去母乳内保护因子，加之牛奶易受污染，如患腹泻易迁延不愈。
慢性腹泻中西医结合疗效好
1.针对病因的措施
麦类过敏所致的腹泻：根本的治疗是停用所有含麦类的食品。初期应给与含果糖与葡萄糖的食物及脱脂牛奶。待病情好转逐渐增加蛋白质食品，如豆浆、瘦牛肉、鱼、鸡肉等。以后酌情增加淀粉及脂肪食品。如再次发生消化不良症状及腹泻，立即恢复初期食品。
糖不耐受所致腹泻：需从食物中去除不耐受的糖。对原发性不耐受糖的患儿，需长期限制糖，但随年龄增长对碳水化合物不耐受会有所改善，此时可适当添加一些牛奶、淀粉和糖。对继发性不耐受糖的患儿，限制糖仅是暂时的，经过数周或数月后，可以逐步恢复正常饮食。
对牛奶过敏所致的腹泻：应从宝宝的食物中去除牛奶。由于羊奶和马奶也有交义过敏反应，所以不能应用。如无人奶，可用豆奶、肉汤和酪蛋白水解物代替牛奶。婴儿的食品简单，可改用代乳粉喂养，同时加辅食品，如蛋黄泥、菜泥、胡萝卜汁等，以后逐渐增加固体食品即可。对牛奶过敏也会随着年龄增大过敏减少。在6个月后可给与少许牛奶以了解是否过敏，若无过敏可逐渐增加牛奶量，一般到了2岁后牛奶过敏巳很少见。
菌群失调所致的腹泻：需停用所有的抗菌素及皮质激素，然后补充肠道正常菌种，以恢复肠道内微生态平衡，使正常菌种占据绝对优势。常用的有双歧杆菌、乳酸杆菌、粪链球菌等。市售的制剂有培菲康、丽珠肠乐、金双歧等。
2.西药的用与忌
常用药：双八面体礞托石粉能吸附病原体，固定毒素，并能加强胃肠粘膜屏障功能，促进受损的肠粘膜修复。常用的制剂有思密达、必奇等。此外，应补充锌、维生素A、B、C、B12及叶酸。
忌用药：易蒙停适用于急、慢性腹泻。但其作用较强，对婴幼儿有不良药物反应，如对中枢神经系统有损害。目前对5岁以下小儿禁用。复方苯乙哌啶用于急、慢性腹泻，对肠道平滑肌有明显的抑制作用。由于此药对小儿可致中毒，所以婴幼儿禁用。药用炭可吸附在肠壁上，减少毒物对肠壁的剌激，并减少肠蠕动，从而起到止泻作用。但是该药吸附作用无选择性，对消化酶活性有影响，长期应用可致小儿营养不良，对3岁以下宝宝不能长期应用。
3.中医治疗方法多
辨证论治：脾胃虚常见久泻不止，便稀不臭，夹有不消化物，食后即泻，食欲不振，面色萎黄，神疲乏力。可用党参10克、茯苓12克，山药 12克，炒苡仁10克，肉果10克，焦山楂10克，煎汤，每日服一剂。脾肾阳虚常见久泻不止，大便清稀，四肢较冷，面色苍白，精神萎软。可用炮姜3克，熟附子3克，柯子10克，炒白术10克，山药12克。煎汤，每日服一剂。
单方、验方、中成药：附子理中丸用于脾肾阳虚久泻。参苓白术散用于脾气虚久泻。焦山楂、鸡内金、炒山药按1:1:2分配，研成细粉，每次服2克，一日3次，用于脾虚久泻。
外敷中药：丁香1份，肉桂2份，共研细末，每次3克，用米醋调成糊状，置于脐部，用纱布包裹，胶布固定，每晚一次。
药物穴位注射：用黄芪注射液1毫升，分别注射双足三里穴，每日一次，连用7天。适用于脾气虚腹泻。
推拿：最常用的是捏脊。从背部骶部捏至颈部。家长以两手拇指与食指合作，将皮肤轻轻捏起，同时向上提，然后拇指向食指方向搓动，均匀前推至颈部为一次。捏脊时间为15分钟，每天一次。由于小儿皮肤较嫩，推拿时可采用姜汁、葱白汁或冬青油润滑皮肤。
慢性腹泻食疗也有效
1.云母(硅酸盐)20克，糯米50克。将云母研成细末。另把糯米放入砂锅中加水适量，煮成稀粥，再调入云母，将粥煮烂，早晚各服一次。有温胃肠、健脾、止泻作用。适用于慢性脾虚泻。
2.苹果一只去皮，放入碗中隔水蒸软，每日吃一只。苹果含有果胶，可吸附毒素和水分，并含鞣酸，有收敛止泻作用。
3.淮山药50克，粳米50克。同煮成粥。每日分两次服。具有健脾止泻功能。对慢性腹泻好。
4.炒苡仁30克，粳米50克，鲜胡萝卜二只。炒苡仁与粳米同煮，半熟后加少切碎的鲜胡萝卜，至煮熟。每日分两次服。有健脾利湿作用。适用于迁慢性腹泻。
5.用10个熟鸡蛋黄放于砂锅内用慢火烤，油烤出后用勺盛出，剩下的黑渣除去。烤出的油分三天服完。每天分三次服。如不愈再服一疗程。
6.山药200克，芡实200克，扁豆100克，将以上食品捣碎和匀。每日30克，代茶饮。有健脾、收敛止泻作用。
慢性腹泻家庭护理很重要
对慢性腹泻的宝宝应加强腹部的保暖和维护臀部的清洁。要适当给宝宝增减衣服，用护肚兜或毛巾围住脐部，以免受凉后会增加肠蠕动，使腹泻加重。由于宝宝腹泻次数多，在肛门周的皮肤往往会发红，应在便后及时用温水清洗臀部，然后在肛门周围涂护手膏或清鱼肝油。应及时更换尿布和受污染的衣裤，洗净后用开水烫，太阳下晒干，以防感染。长期腹泻的宝宝易发生脱肛，表现部分直肠粘膜突出于肛门外，此时家长应用柔软的毛巾将脱垂的直肠粘膜轻轻向上顶。如无效可用中药升麻15克，柴胡10克，当归15克，赤芍30克，煎汤，熏蒸臀部，水温后再清洗，一日2次。
对慢性腹泻的宝宝不应过份限食，否则会引起营养不良。可给与较清淡的食物，和稀饭、焙烂面条、蒸蛋等，食物要少油，少吃含纤维素较多的青菜、芹菜、韭菜等。待腹泻控制后逐渐增加鱼、肉等。在恢复期间为补充腹泻时失去的营养，应选择富含热量和蛋白质的食物，蛋白质的量应增加一倍，以加速生长发育.
复旦大学儿科医院 时毓民教授
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