0~6月龄婴儿功能性胃肠病的临床特征与诊疗进展

doi:10.12372/jcp.2025.25e0693

摘要/Abstract

摘要：

0~6月龄婴儿各系统尚未完全成熟，是功能性胃肠病（FGIDs）高发时期，其中最常见的为婴儿反流和婴儿绞痛。由于婴儿无法准确表达自我感受，且症状和某些器质性疾病重叠，易引发对婴儿关注度过高的家长的焦虑和抑郁情绪。因此临床上合理的诊治和指导能缓解婴儿症状，安抚家长情绪，提升家庭生活质量。目前FGIDs使用的诊断标准包括《罗马Ⅳ：功能性胃肠病》和《婴幼儿功能性消化不良综合征诊断共识》，两者侧重点不同，可根据临床实际情况进行选择。该年龄段婴儿饮食大多为单一的乳类，因此要坚持母乳喂养，由于各种原因无法坚持母乳喂养的婴儿，配方奶喂养需要综合婴儿症状严重程度，家长意愿、经济情况等因素选择。对于FGIDs的干预措施包括健康和养护指导，以及营养干预，一般不需要药物治疗。

关键词: 功能性胃肠病, 诊疗, 进展, 婴儿

Abstract:

Infants aged 0-6 months are at high risk of functional gastrointestinal disorders (FGIDs) derived from immaturity of various systems, among which infant regurgitation and infant colic are predominant. Infants cannot accurately express their feelings, and some symptoms overlap with organic diseases, which are prone to induce anxiety and depression in overly concerned parents. Therefore, appropriate diagnosis and management helps to release symptoms, ease parents’ fear, and improve quality of life. Diagnostic criteria in China include “Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction” and “Chinese expert consensus on the diagnosis of functional dyspepsia syndrome”, which hold different aspects according to concrete conditions and are utilized based on clinical judgement. Infants aged 0-6 months have milk as single nutrition source. Breastfeeding should remain the priority, while specific formula might be chosen in formula-fed infants based on comprehensive considerations including, the severity of problems, parents’ perspective, and family economic burden, etc. Management strategies include health education, nurturing guidance and nutritional intervention. Pharmaceutical treatment is not required in most situations.

Key words: functional gastrointestinal disorders, diagnosis and treatment, progress, infant

中图分类号:

李在玲. 0~6月龄婴儿功能性胃肠病的临床特征与诊疗进展[J]. 临床儿科杂志, 2025, 43(8): 563-568.

LI Zailing. Clinical characteristics, diagnosis and treatment progress of functional gastrointestinal disorders in infants aged 0-6 months[J]. Journal of Clinical Pediatrics, 2025, 43(8): 563-568.

图/表 1

表1

参考文献 32

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疾病	年龄	诊断标准
婴儿反流	3周~12个月	3周~12月龄婴儿需同时满足以下各项：①每天反流≥2次，持续≥3周；②无恶心、呕血、误吸、呼吸暂停、生长迟缓、喂养或吞咽困难、姿势异常
婴儿反刍综合征	3~8个月	同时满足以下各项并持续2个月以上：(1)腹肌、膈肌和舌的反复收缩；(2)胃内容物毫不费力地反流，要么从口中吐出，要么重新咀嚼后再次吞咽；(3)满足以下至少3项以上，①3~8月龄发病；②按照反流或胃食管反流病治疗无效；③无痛苦表情；④睡眠或与人交流时不发作
周期性呕吐综合征	范围较大	同时满足以下各项：①6个月内有2次及以上剧烈的阵发性呕吐，伴或不伴有干呕，发作持续数小时至数天；②每个患儿有自己的发作模式；③发作期相隔数周或数月，期间恢复到基础健康水平
婴儿绞痛	生后早期到5个月	同时满足以下各项：①症状开始和停止均在5月龄之内；②无明显诱因出现的长时间反复哭闹、烦躁或易激惹，难以预防或被安抚；③无生长迟缓、发热或疾病
婴儿排便困难	出生到9个月	<9月龄婴儿同时满足以下各项：①排出或不能排出软便前，至少10分钟的用力和哭闹状态；②无其他健康问题
功能性便秘	出生到成年	<4岁儿童至少满足以下2项以上：①每周排便≤2次；②有大量粪便潴留史；③有排便疼痛和费力史；④有排粗大粪便史；⑤直肠内有大量粪便团块