从临床观点来看,腹泻可以被定义为:[1]World Health Organization. Health topics - diarrhoea. 2017 [internet publication].http://www.who.int/topics/diarrhoea/en/
阅读更多根据病程,腹泻分为急性(≤14日)和迁延性(>14日)。[2]Guerrant RL, Van Gilder T, Steiner TS, et al. Practice guidelines for the management of infectious diarrhea. Clin Infect Dis. 2001 Feb 1;32(3):331-51.http://cid.oxfordjournals.org/content/32/3/331.longhttp://www.ncbi.nlm.nih.gov/pubmed/11170940?tool=bestpractice.com有些专家认为持续30天以上的腹泻为慢性腹泻。
流行病学
在美国,每年有3.75亿腹泻发作病例,其中90万住院治疗,6,000例患者死于腹泻。在世界各地,每年有15亿人腹泻发作,在≤5岁的儿童中,其中150万至200万死于腹泻。[3]Santosham M, Keenan EM, Tulloch J, et al. Oral rehydration therapy for diarrhea: an example of reverse transfer in technology. Pediatrics. 1997 Nov;100(5):E10.http://pediatrics.aappublications.org/cgi/content/full/100/5/e10http://www.ncbi.nlm.nih.gov/pubmed/9347004?tool=bestpractice.comWorld Gastroenterology Organisation: acute diarrhea与之相比,在英格兰和威尔士,每年感染性肠道疾病导致300人死亡和35,000例住院治疗。[4]Wheeler JG, Sethi D, Cowden JM, et al; The Infectious Intestinal Disease Study Executive. Study of infectious intestinal disease in England: rates in the community, presenting to general practice, and reported to national surveillance. BMJ. 1999 Apr 17;318(7190):1046-50.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27838/http://www.ncbi.nlm.nih.gov/pubmed/10205103?tool=bestpractice.com在英格兰,每年约940万例,其中150万例就诊于全科医生。[4]Wheeler JG, Sethi D, Cowden JM, et al; The Infectious Intestinal Disease Study Executive. Study of infectious intestinal disease in England: rates in the community, presenting to general practice, and reported to national surveillance. BMJ. 1999 Apr 17;318(7190):1046-50.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27838/http://www.ncbi.nlm.nih.gov/pubmed/10205103?tool=bestpractice.com
全世界<5岁的儿童中,有16.5%死于腹泻。在2004年,全世界由于腹泻导致死亡占总死亡的3.6%。到 2030 年,这一数值预计将下降至 0.9%。[5]World Health Organization. World health statistics. 2008 [internet publication].http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf对口服补液疗法使用机会增加的实施和对喂养和断奶实践的教育应有助于降低死亡率,尤其是对 5 岁以下年龄组患者。[5]World Health Organization. World health statistics. 2008 [internet publication].http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf
基本病理生理学
除外唾液腺、胃、胰腺、胆管和十二指肠的分泌物,通常每天约由摄取的食物和饮料组成10L液体进入胃肠道。小肠是重吸收的主要场所。总体而言,约 99% 的液体被重新吸收,留下 0.1 L 经粪便排泄。腹泻在各种因素干扰正常进程时就会发生,导致液体和电解质吸收减少或者液体和电解质分泌增加,或者增加肠道的动力。
增加对传染性腹泻病理生理和促使致病因子传播的因素的理解,将有助于对疾病暴发的预防和相应做出实质性措施。[6]Pawlowski SW, Warren CA, Guerrant R. Diagnosis and treatment of acute or persistent diarrhea. Gastroenterology. 2009 May;136(6):1874-86.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723735/http://www.ncbi.nlm.nih.gov/pubmed/19457416?tool=bestpractice.com