目的对腹泻型肠易激综合征(diarrhea-predominant irritable bowel syndrome, D-IBS)和功能性腹泻的腹泻情况进行程度分级,并按分级程度进行阶梯治疗,观察疗效。方法选取2008年6月~2013年11月本院门诊和住院患者中D-IBS和功能性腹泻病例195例,随机分为治疗组(99例)与对照组(96例),按腹泻程度分为轻、中、重三度,治疗组进行四段阶梯式治疗,对照组仅予以止泻药蒙脱石散、洛哌丁胺,并视有无上消化道功能障碍予以伊托必利等,且不加用抗抑郁剂。所有病例至少随访半年。结果阶梯式治疗效果明显优于单用药物治疗者,两组比较治疗效果差异有统计学意义(P<0.05)。结论并非每位腹泻的患者都需止泻药物治疗,相当多患者只需治疗腹泻以外的症状,仅少部分严重患者需要止泻药物和较长疗程的抗焦虑/抑郁治疗。按疾病的严重程度进行分级治疗,按主要症状进行对症治疗是治疗本病的原则。%Objective To classify the severity degrees of diarrhea-predominant irritable bowel syndrome (D-IBS) and functional diarrhea and perform the stepped treatment according to the classification and observe the efficacy. Methods From June 2008 to November 2013, 195 cases of patients with D-IBS and functional diarrhea received clinical service and hospitalized in our hospital were selected and they were divided randomly into treatment group (99 cases) and control group (96 cases). They were classified into mild degree, moderate degree and severe degree according to the diarrhea severity. The escalation therapy was applied in treatment group for 4 stages, and the control group was only treated with antidiarrheal drugs such as montmorillonite powder and loperamide with itopride provided as if they had upper gastrointestinal dysfunction. And no antidepressant was added. Follow-ups were carried out for all patients for more than half a year. Results The effect of escalation therapy was obviously superior to drug therapy alone with significant difference (P<0.05). Conclusion Treatment of antidiarrheal drug is not needed by every diarrhea patient, and a great number of patients only need treatment for symptoms other than diarrhea. Just a few patients of serious degree need the treatment of antidiarrheal drug combined with longer course of anti-anxiety/depression therapy.Grading treatment according to severity classification of the disease and symptomatic treatment according to the main symptoms are the principles for treating the disease.
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