新型 5-羟色胺 (5-HT4) 受体激动剂
针对儿科便秘的新药正在进行测试,其中包括更多的选择性 5-羟色胺 (5-HT4) 受体激动剂(例如,普卢卡必利和莫沙必利)。 一项多中心、安慰剂对照、随机双盲 III 期临床试验评估了普卢卡必利对 6 个月至 18 岁的功能性便秘儿童的效力和安全性,发现该药耐受性好,但并不比安慰剂更有效。[42]Mugie SM, Korczowski B, Bodi P, et al. Prucalopride is no more effective than placebo for children with functional constipation. Gastroenterology. 2014 Dec;147(6):1285-95.e1.http://www.gastrojournal.org/article/S0016-5085%2814%2901127-5/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/25239590?tool=bestpractice.com
肉毒素
将 A 型肉毒杆菌毒素注入肛门内括约肌内显示出了一些有前景的效果,但在推荐之前还需要更多的证据支持。[43]Irani K, Rodriguez L, Doody DP, et al. Botulinum toxin for the treatment of chronic constipation in children with internal anal sphincter dysfunction. Pediatr Surg Int. 2008 Jul;24(7):779-83.http://www.ncbi.nlm.nih.gov/pubmed/18443801?tool=bestpractice.com
益生菌
一项研究发现对婴儿给予益生菌减少了便秘和绞痛。[44]Indrio F, Di Mauro A, Riezzo G, et al. Prophylactic use of a probiotic in the prevention of colic, regurgitation, and functional constipation: a randomized clinical trial. JAMA Pediatr. 2014 Mar;168(3):228-33.http://www.ncbi.nlm.nih.gov/pubmed/24424513?tool=bestpractice.com 但是并没有足够的证据推荐在儿童便秘的常规治疗中使用益生元或益生菌。[45]Macfarlane S, Macfarlane GT, Cummings JH. Review article: prebiotics in the gastrointestinal tract. Aliment Pharmacol Ther. 2006 Sep 1;24(5):701-14.http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2006.03042.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/16918875?tool=bestpractice.com[46]Banaszkiewicz A, Szajewska H. Probiotics in the treatment of constipation: a systematic review of randomized controlled trials. Pediatria Współczesna. 2005;7:9-14.[47]Ford AC, Quigley EM, Lacy BE, et al. Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol. 2014 Oct;109(10):1547-61.http://www.ncbi.nlm.nih.gov/pubmed/25070051?tool=bestpractice.com
骶神经刺激
据报道,骶神经刺激是一种对治疗儿童慢性便秘有益的新型治疗方式。 目前尚不清楚其作用机制,也不了解可能对该治疗有反应的患者类型。[48]Lu ML, He J, Lu S. Electrical stimulation therapy for slow transit constipation in children: a systematic review. Int J Colorectal Dis. 2015 May;30(5):697-702.http://www.ncbi.nlm.nih.gov/pubmed/25772272?tool=bestpractice.com[49]Sulkowski JP, Nacion KM, Deans KJ, et al. Sacral nerve stimulation: a promising therapy for fecal and urinary incontinence and constipation in children. J Pediatr Surg. 2015 Oct;50(10):1644-7.http://www.ncbi.nlm.nih.gov/pubmed/25858097?tool=bestpractice.com