Inflammatory Bowel Disease Center, Division of Gastroenterology, University of California San Diego Health System, La Jolla, CA, USA.
Clin Gastroenterol Hepatol. 2012 Dec;10(12):1315-1325.e4. doi: 10.1016/j.cgh.2012.07.006. Epub 2012 Jul 24.
Ulcerative colitis is a chronic inflammatory disease of the colon; as many as 25% of patients with this disease require hospitalization. The goals of hospitalization are to assess disease severity, exclude infection, administer rapidly acting and highly effective medication regimens, and determine response. During hospitalization, patients should be given venous thromboembolism prophylaxis and monitored for the development of toxic megacolon. Patients who do not respond to intravenous corticosteroids should be considered for rescue therapy with infliximab or cyclosporine. Patients who are refractory to medical therapies or who develop toxic megacolon should be evaluated promptly for colectomy. Patients who do respond to medical therapies should be discharged on an appropriate maintenance regimen when they meet discharge criteria. We review practical evidence-based management principles and propose a day-by-day algorithm for managing patients hospitalized for ulcerative colitis.
溃疡性结肠炎是一种结肠的慢性炎症性疾病；多达 25%的此类患者需要住院治疗。住院的目的是评估疾病的严重程度，排除感染，给予快速起效且高效的药物治疗方案，并确定疗效。住院期间，应给予静脉血栓栓塞预防，并监测是否发生中毒性巨结肠。对静脉用皮质类固醇无反应的患者，应考虑使用英夫利昔单抗或环孢素进行挽救治疗。对药物治疗无反应或发生中毒性巨结肠的患者，应迅速评估是否适合行结肠切除术。对药物治疗有反应的患者，如果符合出院标准，应在出院时给予适当的维持治疗方案。我们复习了实用的循证管理原则，并提出了溃疡性结肠炎患者住院治疗的一日至一日算法。
