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蒙脫石止瀉的機(jī)理
1. 顆粒細(xì)小表面積巨大
蒙脫石是一種硅鋁酸鹽復(fù)合物，具有顆粒型層紋狀結(jié)構(gòu)，每層由四面體氧化硅、八面體氧化鋁和四面體氧化硅三層構(gòu)成，每層厚度僅1nm。由于蒙托石顆粒細(xì)小，所以表面積巨大，每克粉劑可覆蓋100~110 m2消化道表面，顯著提高消化道黏液的質(zhì)和量，加強(qiáng)黏膜屏障的作用，幫助消化道上皮細(xì)胞的恢復(fù)與再生。
2. 不均勻帶電性
蒙托石中的Al3+被Ca2+和Mg2+取代，使得電荷分布不均勻，基本層中帶負(fù)電，層間帶正電，使得蒙托石具有強(qiáng)大的靜電吸附能力。吸附固定抑制多種病毒、病菌及其所產(chǎn)生的毒素，平衡正常菌群，提高消化道的免疫功能。
3. 黏塑性
蒙脫石的基本層與基本層之間可以滑動打開，在消化道延展，層與層之間并不散亂分離，從而形成連續(xù)保護(hù)膜。
蒙脫石止瀉的基礎(chǔ)研究
1輪狀病毒：法國進(jìn)行的一項(xiàng)動物研究顯示，蒙脫石可以保護(hù)黏膜絨毛免受輪狀病毒侵襲，蒙脫石組的腸道黏膜形態(tài)基本保持正常。
2大腸桿菌：家兔回腸感染大腸桿菌后，服用蒙脫石可以減輕黏膜損傷，重建水、電解質(zhì)吸收，促進(jìn)絨毛恢復(fù)正常形態(tài)。、
3空腸彎曲桿菌：空腸彎曲桿菌不僅可以在腸道定植，還可以進(jìn)入血循環(huán)，在身體其他部位定植。使用蒙脫石后，消化道黏膜未見破壞，其他部位也無移位細(xì)菌，側(cè)面說明蒙脫石可促進(jìn)受損小腸黏膜上皮細(xì)胞的再生與修復(fù)，對腸道黏膜屏障有明顯的保護(hù)作用。
4燒傷：未服用蒙脫石的大鼠，在傷后12小時全段小腸黏膜下血管輕度充血，嚴(yán)重者有小灶潰瘍甚至腸上皮脫落呈片狀，腸壁水腫并累及肌間神經(jīng)節(jié)細(xì)胞，傷后1、3天尤為明顯。而蒙脫石治療組大鼠，傷后各時相點(diǎn)腸上皮脫落程度較輕，絨毛形態(tài)完整、排列整齊，腸上皮再生能力較強(qiáng)。
蒙脫石的臨床研究
1 縮短腹瀉持續(xù)時間：一項(xiàng)雙盲安慰劑對照研究顯示，兒童急性腹瀉患者應(yīng)用蒙脫石后，平均腹瀉持續(xù)時間[（54.1±2.35）小時]縮短，與安慰劑組[（72.9±1.98）小時]相比差異顯著（P=0.001）。治療24小時后，蒙脫石組腹瀉持續(xù)存在的患者百分比顯著低于安慰劑組。提示蒙脫石減少父母照顧患兒的時間和患兒住院時間，降低醫(yī)療總支出。另一項(xiàng)納入804例患兒的意大利研究同樣顯示，蒙脫石有效縮短腹瀉持續(xù)時間，治療組腹瀉持續(xù)超過7天者顯著減少。
2減少排便次數(shù)：蒙脫石在縮短腹瀉持續(xù)時間的同時，減少每日排便次數(shù)。一項(xiàng)薈萃分析表明，蒙脫石組的排便頻率在治療期間的任何時段都顯著少于安慰劑組。治療3天后，腹瀉痊愈率明顯提高。
3改變大便性狀：我國天然蒙脫石粉劑療效觀察協(xié)作組在成人慢性腹瀉患者中進(jìn)行的多中心、隨機(jī)、陽性藥物對照研究顯示，蒙脫石對慢性功能性腹瀉患者大便次數(shù)和性狀改變都優(yōu)于雙歧三聯(lián)活菌膠囊。療程各日中，蒙脫石組大便次數(shù)顯著少于安慰劑組，Bristol大便性狀評分也是蒙脫石組優(yōu)于安慰劑組（P=0.001）。
蒙脫石制劑
蒙脫石制劑為止瀉類非處方藥，現(xiàn)常見的蒙脫石制劑有賽立邁、思密達(dá)、必奇、肯特令等。它不同于復(fù)方苯乙哌啶、洛哌丁胺（易蒙停）等腸蠕動抑制劑和鞣酸蛋白、次碳酸鉍、藥用炭等收斂吸附劑。腸蠕動抑制劑可延緩腸內(nèi)容物的排出，使致病微生物同腸黏膜接觸時間延長，使毒性產(chǎn)物的吸收增多，可使病情加重。收斂吸附劑可吸附腸道內(nèi)的營養(yǎng)物質(zhì)，故不推薦使用于兒科。蒙脫石它不改變正常的腸蠕動，不影響食物的正常消化吸收，也不影響葡萄糖和氨基酸的吸收，被認(rèn)為是一種安全、高效的抗腹瀉藥物。
蒙脫石對消化道內(nèi)的致病菌，如致病性大腸桿菌、金葡菌、霍亂弧菌、幽門螺桿菌、空腸彎曲菌等致病菌、病毒（尤其是輪狀病毒），以及它們所產(chǎn)生的毒素、氣體等有極強(qiáng)的吸附、固定、抑制作用，使其失去致病性。實(shí)驗(yàn)證明，口服該藥后，藥物可均勻地覆蓋在整個腸腔表面，并維持6小時之久，而后連同它所吸附的各種攻擊因子隨腸蠕動排出體外，從而避免腸黏膜細(xì)胞被攻擊因子損傷。蒙脫石還能通過與黏液糖蛋白相互結(jié)合，增加黏液凝膠的內(nèi)聚力、粘彈性和存在時間，從而修復(fù)和提高腸道黏膜屏障對各種攻擊因子的防御功能，同時還具有降低結(jié)腸過分敏感性的作用。此外，蒙脫石還可促進(jìn)損傷的消化道黏膜上皮再生，修復(fù)損傷的細(xì)胞間橋，促使細(xì)胞緊密連接；減少腸細(xì)胞的運(yùn)動失調(diào)，恢復(fù)腸蠕動的正常節(jié)律，維護(hù)腸道的輸送和吸收功能；緩解幼兒由于腸道內(nèi)雙糖酶降低或缺乏造成糖脂消化不良而導(dǎo)致的滲透性腹瀉；平衡腸道正常菌群，提高消化道的免疫功能。因而可用于各種急、慢性腹瀉的治療，尤以對兒童急性腹瀉療效為佳。除腹瀉外，蒙脫石制劑還可用于以下疾病的治療：
蒙脫石可明顯增加腸道有益菌群的數(shù)量，對長期應(yīng)用廣譜抗生素造成的腸道菌群失調(diào)和因腸道微生態(tài)紊亂導(dǎo)致的消化不良與腹瀉有顯著治療作用。
蒙脫石還可用于胃食管反流、食管炎以及與胃、十二指腸、結(jié)腸有關(guān)的疼痛的治療。
皰疹性口炎是由單純皰疹病毒引起的急性口腔黏膜感染，目前尚無特效藥治療。蒙脫石對口腔黏膜表面的各種致病因子有固定和抑制作用，并能加強(qiáng)黏膜的屏障作用，促進(jìn)受損黏膜上皮細(xì)胞再生和修復(fù)。方法是：用蒙脫石干粉于進(jìn)食后涂于患處，每天3次，2～7天為1個療程。
蒙脫石可通過激活凝血因子，對消化道局部出血有止血作用；還能加強(qiáng)消化道黏膜的屏障作用，幫助消化道上皮組織的再生修復(fù)；同時可以固定、吸附、清除幽門螺旋桿菌。
蒙脫石散劑還可以這樣用
蒙脫石散劑是一種消化道粘膜保護(hù)劑，具有較強(qiáng)的吸附能力，臨床常用于小兒腹瀉的治療。其實(shí)，蒙脫石散劑在針對小兒疾病的治療中用途還很多，了解這些用途有助于拓展蒙脫石散劑的用藥范圍，并為更多小兒疾病提供新的療法。
1.治療新生兒母乳性黃膽：由于母乳中含有較高濃度的-葡萄糖醛酸苷酶，此酶在腸道可分解結(jié)合膽紅素，增加膽紅素的腸肝循環(huán)，易使腸道功能不全的早產(chǎn)兒、低體重兒在母乳喂養(yǎng)后出現(xiàn)黃疸，稱為母乳性黃疸。蒙脫石散劑能夠減少對膽紅素的吸收，促進(jìn)腸道排泄膽紅素，故而蒙脫石散劑治療母乳性黃疸有效，每次用1/3~1/2包，每日3次，7天為一個療程。
2.治療嬰兒乳糖不耐受癥：由于個別嬰兒體內(nèi)乳糖酶缺乏，使得在喂乳后嬰兒產(chǎn)生不耐受現(xiàn)象，小兒有腹脹、腹瀉、消化不良等癥狀。蒙脫石散劑可改善患兒癥狀，促進(jìn)對乳糖的耐受恢復(fù)，被推薦為嬰兒乳糖不耐受癥的首選藥物之一。也可與乳酶生、維生素B1及維生素B6聯(lián)合應(yīng)用，可以增強(qiáng)療效，促進(jìn)癥狀進(jìn)一步改善。用法為每次1/3包，連用7~10天。
3.治療新生兒消化道出血：對于各種原因引起的新生兒消化道出血，在積極治療原發(fā)疾病的同時，給予蒙脫石散劑具有一定的止血作用。報道指出，給予蒙脫石散劑后3天內(nèi)的止血效應(yīng)可達(dá)95%~100%。用法是將1/3包蒙脫石散劑加生理鹽水2~3ml調(diào)成糊狀，每日3次喂給新生兒，連服3天。
4.治療小兒復(fù)發(fā)性腹痛：腸道平滑肌受到寒冷、飽食或刺激性食物的刺激可發(fā)生痙攣，引起患兒出現(xiàn)反復(fù)發(fā)作性腹痛，屬于小兒復(fù)發(fā)性腹痛的類型之一。這種腹痛為非器質(zhì)性腹痛，多見于6~12歲兒童，給予蒙脫石散劑治療可減少腹痛發(fā)作次數(shù)。治療原則是在保暖、加強(qiáng)飲食調(diào)理及腹部保暖的基礎(chǔ)上，每次給予蒙脫石散劑1包口服，每日3次，連用5~7天。
5.治療嬰幼兒慢性遷延性腹瀉：嬰幼兒慢性遷延性腹瀉是造成小兒營養(yǎng)不良、生長發(fā)育受阻的主要原因之一。對于感染因素所致的嬰幼兒慢性遷延性腹瀉，可在應(yīng)用抗生素的同時給予蒙脫石散劑口服，以減少腸道分泌、保護(hù)腸粘膜，促進(jìn)腹瀉緩解。口服效果差時，還可考慮將蒙脫石散劑與慶大霉素聯(lián)合灌腸給藥，效果更好。
6.治療小兒霉菌性腸炎：體質(zhì)虛弱及長期使用抗菌素的兒童好發(fā)腸道菌群失調(diào)，使得霉菌大量滋生，從而引起霉菌性腸炎。臨床表現(xiàn)為嚴(yán)重腹瀉，每日數(shù)次至十余次，呈現(xiàn)黃綠色水樣便，有粘液，嚴(yán)重時可排出血樣大便，小兒霉菌性腸炎的病程遷延，患兒通常還伴有低熱、惡心、嘔吐、腹痛等癥狀，糞便檢查可見霉菌孢子。給予抗霉菌藥并聯(lián)用蒙脫石散劑，療效可靠，有效率達(dá)95%以上。用法是：1歲內(nèi)給予1/3包，1~4歲給予半包，5歲以上給予1包，每日3次口服，連服7天左右。
7.治療小兒口腔炎：小兒口腔炎及口腔潰瘍均可用蒙脫石散劑糊劑外涂于患處，每日3次。外用蒙脫石散劑敷治小兒口腔炎和口腔潰瘍，其具有明顯的止痛作用，并能夠促進(jìn)口腔炎癥和潰瘍恢復(fù)速度加快，效果良好，可作為常規(guī)藥物應(yīng)用。
The English version
The mechanism of montmorillonite antidiarrheal
1. The particles small surface area
Montmorillonite is a kind of silicon aluminate compound, with granular layer type grain structure, each layer of the tetrahedral silicon oxide, octahedral alumina and tetrahedral silicon oxide of three layers, each layer thickness of only 1 nm. Because montolivo stone particles small, large surface area, per gram of powder covering 100 ~ 110 m2 surface of the digestive tract, significantly increase the quality and quantity of the digestive tract mucous, strengthen the role of mucous membrane barrier, help recovery and regeneration of epithelial cells of the digestive tract.
2. Uneven charge
Montolivo stone of Al3 + was replaced by the Ca2 + and magnesium 2 +, charge distribution is not uniform, negatively charged in the basic layer, layer between the positively charged, makes montolivo stone has strong electrostatic adsorption capacity. Fixed adsorption inhibition produced by a variety of viruses, bacteria and toxins, balance the normal flora, enhance immunity of the digestive tract.
3. The sticky plastic
Montmorillonite between the basic layer and basic layer can slide open, stretch in the digestive tract, not messy separation between layer and layer, forming a continuous protective film.
Montmorillonite antidiarrheal basic research
1 rotavirus: France for an animal studies have shown that montmorillonite can protect mucosal villi from rotavirus, montmorillonite group basic maintain normal intestinal mucosa form.
E. coli 2: rabbit ileum after infected with e. coli, taking montmorillonite can relieve mucosa damage, reconstruction of water and electrolyte absorption, promote hair returned to normal form. ,
3 jejunum campylobacter: jejunum campylobacter can colonize the gut, not only can also enter the blood circulation, in other parts of the body engraftment. Using montmorillonite, did not see the digestive tract mucosa damage, also in other parts of undisplaced bacteria, the side that montmorillonite can promote the small intestinal mucosa epithelial cells regeneration and repair damaged, has obvious protective effect on intestinal mucosa barrier.
4.Burns: not taking montmorillonite rats, 12 hours after injury segment under the small intestinal mucosa, vascular mild hyperemia, serious ulcers have a stove intestinal epithelium even fall off a flake, intestinal wall edema and involvement between muscle ganglion cells, 1, 3 days after injury. And montmorillonite treatment group rats, injury after each phase of intestinal epithelial shedding to a lesser degree, fluffy form complete and neat rows and intestinal epithelial regeneration ability is stronger.
The clinical research of montmorillonite
Shorten the duration of diarrhea: a double-blind, placebo-controlled study showed that children with acute diarrhea after application of montmorillonite, the average duration of diarrhea (54.1 + 2.35) hours shortened, with the placebo group] [(72.9 + 1.98) hours compared with significant difference (P = 0.001). 24 hours after treatment, the montmorillonite group the percentage of patients in persistent diarrhea significantly lower than that of the placebo group. Prompt montmorillonite reduce the time of the parents to take care of the children and children with length of hospital stay, reduce medical expenditure. Another in 804 cases of children with Italian study also showed that montmorillonite effectively shorten the duration of diarrhea, the treatment group significantly reduced diarrhea lasts more than 7 days.
2 reduce stool frequency: montmorillonite in shortening the duration of diarrhea and at the same time, reduce the daily stool frequency. , according to a meta-analysis of montmorillonite group defecation frequency during any period of time are significantly less than the placebo group. Three days after treatment, diarrhea obviously improve the cure rate.
3 change shit character: curative effect observation of natural montmorillonite powder in China cooperation in adult patients with chronic diarrhea multicenter, randomized, positive drug control study showed that montmorillonite defecate number and character changes in patients with chronic functional diarrhea were superior to the colon triple viable capsules. Treatment between Japan and China, montmorillonite defecate frequency was significantly less than the placebo group, Bristol stool trait score is montmorillonite is better than a placebo group (P = 0.001).
Montmorillonite preparation
Montmorillonite preparation so far have diarrhoea kind of non-prescription drugs, are now common montmorillonite preparation has limai, smecta, will, Kent, etc. It is different from compound phenylethyl piperidine, loperamide (easy to be stopped), and other intestinal peristalsis inhibitors and tannic acid protein, bismuth carbonate, such as medicinal carbon adsorbent of convergence. Intestinal peristalsis inhibitors can delay the discharge of the intestinal contents, make the pathogenic microbes with prolonged contact bowel mucosa, multiply the absorption of toxic products, can make an illness aggravating. Convergence adsorbent adsorption in the intestines of nutrients, therefore, not recommended to use in pediatrics. Montmorillonite does not change its normal bowel movements, does not affect the normal digestion and absorption of food, also does not affect the absorption of glucose and amino acids, is considered to be a safe and efficient drug diarrhea.
Montmorillonite on the pathogenic bacteria in the digestive tract, such as pathogenic e. coli and s. aureus bacteria, vibrio cholerae, helicobacter pylori, jejunum bending bacteria and other pathogenic bacteria, viruses, particularly rotavirus, and their toxins, such as gas produced strong adsorption, fixed, inhibition, lose its pathogenicity. Experiments show that the oral drug, the drug can cover evenly throughout the surface of the lumen, and maintain the 6 hours, then along with its various attacks factors of adsorption with bowel movements eduction body outside, thereby avoiding intestinal mucosa cells were attack damage factor. Montmorillonite can also through the mutual combination of mucous glycoprotein, increasing the cohesion of mucus gel, viscoelastic and existence of time, so as to repair and improve the defence function of intestinal mucosa barrier attacks on various factors, also have the effect that reduce colon excessive sensitivity. In addition, the montmorillonite also can promote the damage of digestive tract mucosal epithelial regeneration, repair the damage of intercellular Bridges, prompting cells closely connected; Reduce the ataxia intestinal cells, to restore the normal rhythm of intestinal peristalsis, transmission and maintenance of intestinal absorption function; Ease children caused by intestinal disaccharidase lower or the lack of the permeability of glycolipids indigestion and cause diarrhea; Balance the intestinal normal flora, enhance immunity of the digestive tract. Thus can be used for the treatment of various acute and chronic diarrhea, especially for children with acute diarrhea curative effect is better. In addition to the diarrhea, montmorillonite preparation can also be used for the treatment of diseases:
Montmorillonite can obviously increase the number of beneficial bacteria in the intestine, broad-spectrum antibiotics for a long time, causing intestinal dysbacteriosis and the intestinal microecological disorder because of the indigestion and diarrhea caused by a significant therapeutic effect.
Montmorillonite can also be used for gastroesophageal reflux esophagitis, related to the stomach, duodenal, colon and the treatment of pain.
Herpetic stomatitis is caused by herpes simplex virus of acute infection of the oral mucosa, there is no specific treatment. Montmorillonite on various pathogenic factors were fixed on the surface of the oral mucosa and inhibition, and can strengthen the mucous membrane barrier function, promote the damaged mucosa epithelial cells regeneration and repair. The method is: use montmorillonite powder to apply to the affected area, after eating 3 times a day, 2 ~ 7 days for a course of treatment.
Montmorillonite can be activated clotting factors, local bleeding hemostatic effects on the digestive tract; Also can strengthen the digestive tract mucous membrane barrier function, help gastrointestinal epithelial tissue regeneration repair; At the same time can be fixed, adsorption and removal of h. pylori.
Montmorillonite powder can also use
Montmorillonite powder is a kind of digestive tract mucosal protective agent, has strong adsorption ability, the clinical commonly used in the treatment of infantile diarrhea. Actually, montmorillonite powder on the treatment of pediatric diseases also USES a lot of, understanding these USES will help expand the use of the montmorillonite powder, and provide a new therapy for more pediatric diseases.
(1) in treatment of neonatal breast milk jaundice: as the mother's milk contains high levels of - glucuronic acid glycosides enzyme, the enzyme in the gut can be decomposed in combination with bilirubin, adding bilirubin enterohepatic circulation, make easily bowel dysfunction of premature and low birthweight babies after breast-feeding jaundice, called breast milk jaundice. Montmorillonite powder can reduce the absorption of bilirubin, promote the intestinal excretion bilirubin, and montmorillonite powder in treatment of breast milk jaundice effectively, with 1/3 ~ 1/2 bag every time, 3 times a day, 7 days for a period of treatment.
2. Baby lactose intolerance syndrome: treatment due to individual baby lactase deficiency, caused the baby after breast intolerance, children have symptoms such as bloating, diarrhea, indigestion. Montmorillonite powder can improve the symptoms of children, promote the recovery of lactose tolerance, recommended for babies one of the first selection medicaments of lactose intolerance syndrome. Can also be associated with lactasinum biofermin, vitamin B1 and vitamin B6, can enhance curative effect, promote the further improvement. A laparoscope, usually connected to a usage for each 1/3 package, 7 ~ 10 days.
3. The treatment of neonatal gastrointestinal hemorrhage: for all kinds of causes of neonatal gastrointestinal bleeding, and at the same time of actively treating the primary disease, giving montmorillonite powder has certain hemostatic effect. Report points out, given montmorillonite powder within 3 days after hemostatic effect can reach 95% ~ 100%. Usage is fold 1/3 of montmorillonite powder plus saline 2 ~ 3 ml tune into a paste, 3 times daily feed a newborn, even served three days.
4. The treatment of children with recurrent abdominal pain, intestinal smooth muscle is cold, feed, or excitant food stimulation of cramps can occur, causing children appear repeatedly paroxysmal abdominal pain, belong to one of the types of children with recurrent abdominal pain. The abdominal pain as a physical pain, see more at 6 ~ 12 years old children, given montmorillonite powder treatment can reduce the number of onset of abdominal pain. Treatment principle is to strengthen diet in the warm, and warm abdomen, on the basis of given montmorillonite powder 1 package oral every time, 3 times a day, stay 5 ~ 7 days.
5. Treatment of infants and young children chronic protracted diarrhea: infants and young children caused pediatric chronic diarrhea is found to be one of the leading causes of malnutrition, the growth and development. For infants and young children caused by chronic protracted diarrhea, infection factors in the application of antibiotics at the same time give montmorillonite powder oral, in order to reduce the intestinal secretion, protect intestinal mucosa, promote the diarrhea. Poor oral effect, still can consider to montmorillonite powder and gentamycin combined enema to medicine, the effect is better.
6. Treatment of infantile enteritis mould: frail and long-term use of antibiotics in children with intestinal flora imbalance, makes mold infested, that cause mould enteritis. Clinical characterized by severe diarrhea, several times a day to more than 10 times, rendering, yellow-green stool watery mucus, serious when can discharge blood stool, pediatric illnesses out mould enteritis, children are usually accompanied by low thermal, symptoms such as nausea, vomiting, abdominal pain, merthiolate-iodine-formaldehyde visible mold spores. Given anti-fungal drugs in parallel with montmorillonite powder, curative effect is reliable, efficient of more than 95%. Usage: within one year of age to give a third package, given half a pack 1 ~ 4 years old, 5 years of age or older to give 1 package, oral three times a day, even served 7 days or so.
7. Treatment of pediatric stomatitis: pediatric stomatitis and oral ulcer are available outside the montmorillonite powder paste on affected area, 3 times a day. Topical montmorillonite powder apply to cure stomatitis and oral ulcer, it has obvious analgesic effect, and can promote oral inflammation and ulcer recovery speed, good effect, can be applied as a conventional drugs.
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