European Association of Poisons Centres and Clinical Toxicologists , Brussels , Belgium.
Clin Toxicol (Phila). 2015 Jan;53(1):5-12. doi: 10.3109/15563650.2014.989326. Epub 2014 Dec 16.
A position paper on the use of whole bowel irrigation (WBI) was first published in 1997 by the American Academy of Clinical Toxicology (AACT) and the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) and updated in 2004. The aims of this paper are to briefly summarize the content of the 2004 Position Paper and to present any new data and recommendations.
A systematic review of the literature from January 2003 to February 28, 2013 was conducted using multiple online databases for articles concerning WBI for gastrointestinal decontamination. An evidence table was created for applicable articles. The authors produced the initial draft that was reviewed by AACT and EAPCCT.
The literature search produced 60 articles with the possibility of applicable human data. Based mainly on volunteer studies, WBI can be considered for potentially toxic ingestions of sustained-release or enteric-coated drugs particularly for those patients presenting later than 2 h after drug ingestion when activated charcoal is less effective. WBI can be considered for patients who have ingested substantial amounts of iron, lithium, or potassium as the morbidity is high and there is a lack of other potentially effective options for gastrointestinal decontamination. WBI can be considered for removal of ingested packets of illicit drugs in "body packers." However, controlled data documenting improvement in clinical outcome after WBI are lacking. WBI is contraindicated in patients with bowel obstruction, perforation, or ileus, and in patients with hemodynamic instability or compromised unprotected airways. WBI should be used cautiously in debilitated patients and in patients with medical conditions that might be further compromised by its use. The concurrent administration of activated charcoal and WBI might decrease the effectiveness of the charcoal. The clinical relevance of this interaction is uncertain.
WBI can facilitate removal of select toxicants from the gastrointestinal tract in some patients, but there is no convincing evidence from clinical studies that it improves the outcome of poisoned patients. There is no new evidence that would require a major revision of the conclusions of the 2004 position statement.
美国临床毒理学院（AACT）和欧洲中毒中心和临床毒理学家协会（EAPCCT）于 1997 年首次发表了一篇关于全肠道灌洗（WBI）使用的立场文件，并于 2004 年进行了更新。本文的目的是简要总结 2004 年立场文件的内容，并提出任何新的数据和建议。
使用多个在线数据库对 2003 年 1 月至 2013 年 2 月 28 日的文献进行了系统回顾，检索有关 WBI 用于胃肠道去污的文章。为适用的文章创建了一个证据表。作者撰写了初稿，并由 AACT 和 EAPCCT 进行了审查。
文献检索产生了 60 篇可能包含人类适用数据的文章。主要基于志愿者研究，WBI 可考虑用于持续释放或肠溶药物的潜在毒性摄入，特别是对于那些在药物摄入后 2 小时以后出现的患者，此时活性炭的效果较差。WBI 可考虑用于摄入大量铁、锂或钾的患者，因为发病率高，而且缺乏其他有效的胃肠道去污方法。WBI 可考虑用于清除“包裹者”摄入的非法药物包。然而，缺乏关于 WBI 后临床结局改善的对照数据。WBI 禁忌用于肠梗阻、穿孔或肠麻痹患者，以及血流动力学不稳定或气道未受保护的患者。WBI 应谨慎用于虚弱患者和可能因使用而进一步受损的患者。同时给予活性炭和 WBI 可能会降低活性炭的效果。这种相互作用的临床相关性尚不确定。
WBI 可以帮助一些患者从胃肠道中清除某些有毒物质，但没有来自临床研究的令人信服的证据表明它可以改善中毒患者的结局。没有新的证据需要对 2004 年立场声明的结论进行重大修订。
