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蒙脱石止泻的机理
1. 颗粒细小表面积巨大
蒙脱石是一种硅铝酸盐复合物，具有颗粒型层纹状结构，每层由四面体氧化硅、八面体氧化铝和四面体氧化硅三层构成，每层厚度仅1nm。由于蒙托石颗粒细小，所以表面积巨大，每克粉剂可覆盖100~110 m2消化道表面，显著提高消化道黏液的质和量，加强黏膜屏障的作用，帮助消化道上皮细胞的恢复与再生。
2. 不均匀带电性
蒙托石中的Al3+被Ca2+和Mg2+取代，使得电荷分布不均匀，基本层中带负电，层间带正电，使得蒙托石具有强大的静电吸附能力。吸附固定抑制多种病毒、病菌及其所产生的毒素，平衡正常菌群，提高消化道的免疫功能。
3. 黏塑性
蒙脱石的基本层与基本层之间可以滑动打开，在消化道延展，层与层之间并不散乱分离，从而形成连续保护膜。
蒙脱石止泻的基础研究
1轮状病毒：法国进行的一项动物研究显示，蒙脱石可以保护黏膜绒毛免受轮状病毒侵袭，蒙脱石组的肠道黏膜形态基本保持正常。
2大肠杆菌：家兔回肠感染大肠杆菌后，服用蒙脱石可以减轻黏膜损伤，重建水、电解质吸收，促进绒毛恢复正常形态。、
3空肠弯曲杆菌：空肠弯曲杆菌不仅可以在肠道定植，还可以进入血循环，在身体其他部位定植。使用蒙脱石后，消化道黏膜未见破坏，其他部位也无移位细菌，侧面说明蒙脱石可促进受损小肠黏膜上皮细胞的再生与修复，对肠道黏膜屏障有明显的保护作用。
4烧伤：未服用蒙脱石的大鼠，在伤后12小时全段小肠黏膜下血管轻度充血，严重者有小灶溃疡甚至肠上皮脱落呈片状，肠壁水肿并累及肌间神经节细胞，伤后1、3天尤为明显。而蒙脱石治疗组大鼠，伤后各时相点肠上皮脱落程度较轻，绒毛形态完整、排列整齐，肠上皮再生能力较强。
蒙脱石的临床研究
1 缩短腹泻持续时间：一项双盲安慰剂对照研究显示，儿童急性腹泻患者应用蒙脱石后，平均腹泻持续时间[（54.1±2.35）小时]缩短，与安慰剂组[（72.9±1.98）小时]相比差异显著（P=0.001）。治疗24小时后，蒙脱石组腹泻持续存在的患者百分比显著低于安慰剂组。提示蒙脱石减少父母照顾患儿的时间和患儿住院时间，降低医疗总支出。另一项纳入804例患儿的意大利研究同样显示，蒙脱石有效缩短腹泻持续时间，治疗组腹泻持续超过7天者显著减少。
2减少排便次数：蒙脱石在缩短腹泻持续时间的同时，减少每日排便次数。一项荟萃分析表明，蒙脱石组的排便频率在治疗期间的任何时段都显著少于安慰剂组。治疗3天后，腹泻痊愈率明显提高。
3改变大便性状：我国天然蒙脱石粉剂疗效观察协作组在成人慢性腹泻患者中进行的多中心、随机、阳性药物对照研究显示，蒙脱石对慢性功能性腹泻患者大便次数和性状改变都优于双歧三联活菌胶囊。疗程各日中，蒙脱石组大便次数显著少于安慰剂组，Bristol大便性状评分也是蒙脱石组优于安慰剂组（P=0.001）。
蒙脱石制剂
蒙脱石制剂为止泻类非处方药，现常见的蒙脱石制剂有赛立迈、思密达、必奇、肯特令等。它不同于复方苯乙哌啶、洛哌丁胺（易蒙停）等肠蠕动抑制剂和鞣酸蛋白、次碳酸铋、药用炭等收敛吸附剂。肠蠕动抑制剂可延缓肠内容物的排出，使致病微生物同肠黏膜接触时间延长，使毒性产物的吸收增多，可使病情加重。收敛吸附剂可吸附肠道内的营养物质，故不推荐使用于儿科。蒙脱石它不改变正常的肠蠕动，不影响食物的正常消化吸收，也不影响葡萄糖和氨基酸的吸收，被认为是一种安全、高效的抗腹泻药物。
蒙脱石对消化道内的致病菌，如致病性大肠杆菌、金葡菌、霍乱弧菌、幽门螺杆菌、空肠弯曲菌等致病菌、病毒（尤其是轮状病毒），以及它们所产生的毒素、气体等有极强的吸附、固定、抑制作用，使其失去致病性。实验证明，口服该药后，药物可均匀地覆盖在整个肠腔表面，并维持6小时之久，而后连同它所吸附的各种攻击因子随肠蠕动排出体外，从而避免肠黏膜细胞被攻击因子损伤。蒙脱石还能通过与黏液糖蛋白相互结合，增加黏液凝胶的内聚力、粘弹性和存在时间，从而修复和提高肠道黏膜屏障对各种攻击因子的防御功能，同时还具有降低结肠过分敏感性的作用。此外，蒙脱石还可促进损伤的消化道黏膜上皮再生，修复损伤的细胞间桥，促使细胞紧密连接；减少肠细胞的运动失调，恢复肠蠕动的正常节律，维护肠道的输送和吸收功能；缓解幼儿由于肠道内双糖酶降低或缺乏造成糖脂消化不良而导致的渗透性腹泻；平衡肠道正常菌群，提高消化道的免疫功能。因而可用于各种急、慢性腹泻的治疗，尤以对儿童急性腹泻疗效为佳。除腹泻外，蒙脱石制剂还可用于以下疾病的治疗：
蒙脱石可明显增加肠道有益菌群的数量，对长期应用广谱抗生素造成的肠道菌群失调和因肠道微生态紊乱导致的消化不良与腹泻有显著治疗作用。
蒙脱石还可用于胃食管反流、食管炎以及与胃、十二指肠、结肠有关的疼痛的治疗。
疱疹性口炎是由单纯疱疹病毒引起的急性口腔黏膜感染，目前尚无特效药治疗。蒙脱石对口腔黏膜表面的各种致病因子有固定和抑制作用，并能加强黏膜的屏障作用，促进受损黏膜上皮细胞再生和修复。方法是：用蒙脱石干粉于进食后涂于患处，每天3次，2～7天为1个疗程。
蒙脱石可通过激活凝血因子，对消化道局部出血有止血作用；还能加强消化道黏膜的屏障作用，帮助消化道上皮组织的再生修复；同时可以固定、吸附、清除幽门螺旋杆菌。
蒙脱石散剂还可以这样用
蒙脱石散剂是一种消化道粘膜保护剂，具有较强的吸附能力，临床常用于小儿腹泻的治疗。其实，蒙脱石散剂在针对小儿疾病的治疗中用途还很多，了解这些用途有助于拓展蒙脱石散剂的用药范围，并为更多小儿疾病提供新的疗法。
1.治疗新生儿母乳性黄胆：由于母乳中含有较高浓度的-葡萄糖醛酸苷酶，此酶在肠道可分解结合胆红素，增加胆红素的肠肝循环，易使肠道功能不全的早产儿、低体重儿在母乳喂养后出现黄疸，称为母乳性黄疸。蒙脱石散剂能够减少对胆红素的吸收，促进肠道排泄胆红素，故而蒙脱石散剂治疗母乳性黄疸有效，每次用1/3~1/2包，每日3次，7天为一个疗程。
2.治疗婴儿乳糖不耐受症：由于个别婴儿体内乳糖酶缺乏，使得在喂乳后婴儿产生不耐受现象，小儿有腹胀、腹泻、消化不良等症状。蒙脱石散剂可改善患儿症状，促进对乳糖的耐受恢复，被推荐为婴儿乳糖不耐受症的首选药物之一。也可与乳酶生、维生素B1及维生素B6联合应用，可以增强疗效，促进症状进一步改善。用法为每次1/3包，连用7~10天。
3.治疗新生儿消化道出血：对于各种原因引起的新生儿消化道出血，在积极治疗原发疾病的同时，给予蒙脱石散剂具有一定的止血作用。报道指出，给予蒙脱石散剂后3天内的止血效应可达95%~100%。用法是将1/3包蒙脱石散剂加生理盐水2~3ml调成糊状，每日3次喂给新生儿，连服3天。
4.治疗小儿复发性腹痛：肠道平滑肌受到寒冷、饱食或刺激性食物的刺激可发生痉挛，引起患儿出现反复发作性腹痛，属于小儿复发性腹痛的类型之一。这种腹痛为非器质性腹痛，多见于6~12岁儿童，给予蒙脱石散剂治疗可减少腹痛发作次数。治疗原则是在保暖、加强饮食调理及腹部保暖的基础上，每次给予蒙脱石散剂1包口服，每日3次，连用5~7天。
5.治疗婴幼儿慢性迁延性腹泻：婴幼儿慢性迁延性腹泻是造成小儿营养不良、生长发育受阻的主要原因之一。对于感染因素所致的婴幼儿慢性迁延性腹泻，可在应用抗生素的同时给予蒙脱石散剂口服，以减少肠道分泌、保护肠粘膜，促进腹泻缓解。口服效果差时，还可考虑将蒙脱石散剂与庆大霉素联合灌肠给药，效果更好。
6.治疗小儿霉菌性肠炎：体质虚弱及长期使用抗菌素的儿童好发肠道菌群失调，使得霉菌大量滋生，从而引起霉菌性肠炎。临床表现为严重腹泻，每日数次至十余次，呈现黄绿色水样便，有粘液，严重时可排出血样大便，小儿霉菌性肠炎的病程迁延，患儿通常还伴有低热、恶心、呕吐、腹痛等症状，粪便检查可见霉菌孢子。给予抗霉菌药并联用蒙脱石散剂，疗效可靠，有效率达95%以上。用法是：1岁内给予1/3包，1~4岁给予半包，5岁以上给予1包，每日3次口服，连服7天左右。
7.治疗小儿口腔炎：小儿口腔炎及口腔溃疡均可用蒙脱石散剂糊剂外涂于患处，每日3次。外用蒙脱石散剂敷治小儿口腔炎和口腔溃疡，其具有明显的止痛作用，并能够促进口腔炎症和溃疡恢复速度加快，效果良好，可作为常规药物应用。
The English version
The mechanism of montmorillonite antidiarrheal
1. The particles small surface area
Montmorillonite is a kind of silicon aluminate compound, with granular layer type grain structure, each layer of the tetrahedral silicon oxide, octahedral alumina and tetrahedral silicon oxide of three layers, each layer thickness of only 1 nm. Because montolivo stone particles small, large surface area, per gram of powder covering 100 ~ 110 m2 surface of the digestive tract, significantly increase the quality and quantity of the digestive tract mucous, strengthen the role of mucous membrane barrier, help recovery and regeneration of epithelial cells of the digestive tract.
2. Uneven charge
Montolivo stone of Al3 + was replaced by the Ca2 + and magnesium 2 +, charge distribution is not uniform, negatively charged in the basic layer, layer between the positively charged, makes montolivo stone has strong electrostatic adsorption capacity. Fixed adsorption inhibition produced by a variety of viruses, bacteria and toxins, balance the normal flora, enhance immunity of the digestive tract.
3. The sticky plastic
Montmorillonite between the basic layer and basic layer can slide open, stretch in the digestive tract, not messy separation between layer and layer, forming a continuous protective film.
Montmorillonite antidiarrheal basic research
1 rotavirus: France for an animal studies have shown that montmorillonite can protect mucosal villi from rotavirus, montmorillonite group basic maintain normal intestinal mucosa form.
E. coli 2: rabbit ileum after infected with e. coli, taking montmorillonite can relieve mucosa damage, reconstruction of water and electrolyte absorption, promote hair returned to normal form. ,
3 jejunum campylobacter: jejunum campylobacter can colonize the gut, not only can also enter the blood circulation, in other parts of the body engraftment. Using montmorillonite, did not see the digestive tract mucosa damage, also in other parts of undisplaced bacteria, the side that montmorillonite can promote the small intestinal mucosa epithelial cells regeneration and repair damaged, has obvious protective effect on intestinal mucosa barrier.
4.Burns: not taking montmorillonite rats, 12 hours after injury segment under the small intestinal mucosa, vascular mild hyperemia, serious ulcers have a stove intestinal epithelium even fall off a flake, intestinal wall edema and involvement between muscle ganglion cells, 1, 3 days after injury. And montmorillonite treatment group rats, injury after each phase of intestinal epithelial shedding to a lesser degree, fluffy form complete and neat rows and intestinal epithelial regeneration ability is stronger.
The clinical research of montmorillonite
Shorten the duration of diarrhea: a double-blind, placebo-controlled study showed that children with acute diarrhea after application of montmorillonite, the average duration of diarrhea (54.1 + 2.35) hours shortened, with the placebo group] [(72.9 + 1.98) hours compared with significant difference (P = 0.001). 24 hours after treatment, the montmorillonite group the percentage of patients in persistent diarrhea significantly lower than that of the placebo group. Prompt montmorillonite reduce the time of the parents to take care of the children and children with length of hospital stay, reduce medical expenditure. Another in 804 cases of children with Italian study also showed that montmorillonite effectively shorten the duration of diarrhea, the treatment group significantly reduced diarrhea lasts more than 7 days.
2 reduce stool frequency: montmorillonite in shortening the duration of diarrhea and at the same time, reduce the daily stool frequency. , according to a meta-analysis of montmorillonite group defecation frequency during any period of time are significantly less than the placebo group. Three days after treatment, diarrhea obviously improve the cure rate.
3 change shit character: curative effect observation of natural montmorillonite powder in China cooperation in adult patients with chronic diarrhea multicenter, randomized, positive drug control study showed that montmorillonite defecate number and character changes in patients with chronic functional diarrhea were superior to the colon triple viable capsules. Treatment between Japan and China, montmorillonite defecate frequency was significantly less than the placebo group, Bristol stool trait score is montmorillonite is better than a placebo group (P = 0.001).
Montmorillonite preparation
Montmorillonite preparation so far have diarrhoea kind of non-prescription drugs, are now common montmorillonite preparation has limai, smecta, will, Kent, etc. It is different from compound phenylethyl piperidine, loperamide (easy to be stopped), and other intestinal peristalsis inhibitors and tannic acid protein, bismuth carbonate, such as medicinal carbon adsorbent of convergence. Intestinal peristalsis inhibitors can delay the discharge of the intestinal contents, make the pathogenic microbes with prolonged contact bowel mucosa, multiply the absorption of toxic products, can make an illness aggravating. Convergence adsorbent adsorption in the intestines of nutrients, therefore, not recommended to use in pediatrics. Montmorillonite does not change its normal bowel movements, does not affect the normal digestion and absorption of food, also does not affect the absorption of glucose and amino acids, is considered to be a safe and efficient drug diarrhea.
Montmorillonite on the pathogenic bacteria in the digestive tract, such as pathogenic e. coli and s. aureus bacteria, vibrio cholerae, helicobacter pylori, jejunum bending bacteria and other pathogenic bacteria, viruses, particularly rotavirus, and their toxins, such as gas produced strong adsorption, fixed, inhibition, lose its pathogenicity. Experiments show that the oral drug, the drug can cover evenly throughout the surface of the lumen, and maintain the 6 hours, then along with its various attacks factors of adsorption with bowel movements eduction body outside, thereby avoiding intestinal mucosa cells were attack damage factor. Montmorillonite can also through the mutual combination of mucous glycoprotein, increasing the cohesion of mucus gel, viscoelastic and existence of time, so as to repair and improve the defence function of intestinal mucosa barrier attacks on various factors, also have the effect that reduce colon excessive sensitivity. In addition, the montmorillonite also can promote the damage of digestive tract mucosal epithelial regeneration, repair the damage of intercellular Bridges, prompting cells closely connected; Reduce the ataxia intestinal cells, to restore the normal rhythm of intestinal peristalsis, transmission and maintenance of intestinal absorption function; Ease children caused by intestinal disaccharidase lower or the lack of the permeability of glycolipids indigestion and cause diarrhea; Balance the intestinal normal flora, enhance immunity of the digestive tract. Thus can be used for the treatment of various acute and chronic diarrhea, especially for children with acute diarrhea curative effect is better. In addition to the diarrhea, montmorillonite preparation can also be used for the treatment of diseases:
Montmorillonite can obviously increase the number of beneficial bacteria in the intestine, broad-spectrum antibiotics for a long time, causing intestinal dysbacteriosis and the intestinal microecological disorder because of the indigestion and diarrhea caused by a significant therapeutic effect.
Montmorillonite can also be used for gastroesophageal reflux esophagitis, related to the stomach, duodenal, colon and the treatment of pain.
Herpetic stomatitis is caused by herpes simplex virus of acute infection of the oral mucosa, there is no specific treatment. Montmorillonite on various pathogenic factors were fixed on the surface of the oral mucosa and inhibition, and can strengthen the mucous membrane barrier function, promote the damaged mucosa epithelial cells regeneration and repair. The method is: use montmorillonite powder to apply to the affected area, after eating 3 times a day, 2 ~ 7 days for a course of treatment.
Montmorillonite can be activated clotting factors, local bleeding hemostatic effects on the digestive tract; Also can strengthen the digestive tract mucous membrane barrier function, help gastrointestinal epithelial tissue regeneration repair; At the same time can be fixed, adsorption and removal of h. pylori.
Montmorillonite powder can also use
Montmorillonite powder is a kind of digestive tract mucosal protective agent, has strong adsorption ability, the clinical commonly used in the treatment of infantile diarrhea. Actually, montmorillonite powder on the treatment of pediatric diseases also USES a lot of, understanding these USES will help expand the use of the montmorillonite powder, and provide a new therapy for more pediatric diseases.
(1) in treatment of neonatal breast milk jaundice: as the mother's milk contains high levels of - glucuronic acid glycosides enzyme, the enzyme in the gut can be decomposed in combination with bilirubin, adding bilirubin enterohepatic circulation, make easily bowel dysfunction of premature and low birthweight babies after breast-feeding jaundice, called breast milk jaundice. Montmorillonite powder can reduce the absorption of bilirubin, promote the intestinal excretion bilirubin, and montmorillonite powder in treatment of breast milk jaundice effectively, with 1/3 ~ 1/2 bag every time, 3 times a day, 7 days for a period of treatment.
2. Baby lactose intolerance syndrome: treatment due to individual baby lactase deficiency, caused the baby after breast intolerance, children have symptoms such as bloating, diarrhea, indigestion. Montmorillonite powder can improve the symptoms of children, promote the recovery of lactose tolerance, recommended for babies one of the first selection medicaments of lactose intolerance syndrome. Can also be associated with lactasinum biofermin, vitamin B1 and vitamin B6, can enhance curative effect, promote the further improvement. A laparoscope, usually connected to a usage for each 1/3 package, 7 ~ 10 days.
3. The treatment of neonatal gastrointestinal hemorrhage: for all kinds of causes of neonatal gastrointestinal bleeding, and at the same time of actively treating the primary disease, giving montmorillonite powder has certain hemostatic effect. Report points out, given montmorillonite powder within 3 days after hemostatic effect can reach 95% ~ 100%. Usage is fold 1/3 of montmorillonite powder plus saline 2 ~ 3 ml tune into a paste, 3 times daily feed a newborn, even served three days.
4. The treatment of children with recurrent abdominal pain, intestinal smooth muscle is cold, feed, or excitant food stimulation of cramps can occur, causing children appear repeatedly paroxysmal abdominal pain, belong to one of the types of children with recurrent abdominal pain. The abdominal pain as a physical pain, see more at 6 ~ 12 years old children, given montmorillonite powder treatment can reduce the number of onset of abdominal pain. Treatment principle is to strengthen diet in the warm, and warm abdomen, on the basis of given montmorillonite powder 1 package oral every time, 3 times a day, stay 5 ~ 7 days.
5. Treatment of infants and young children chronic protracted diarrhea: infants and young children caused pediatric chronic diarrhea is found to be one of the leading causes of malnutrition, the growth and development. For infants and young children caused by chronic protracted diarrhea, infection factors in the application of antibiotics at the same time give montmorillonite powder oral, in order to reduce the intestinal secretion, protect intestinal mucosa, promote the diarrhea. Poor oral effect, still can consider to montmorillonite powder and gentamycin combined enema to medicine, the effect is better.
6. Treatment of infantile enteritis mould: frail and long-term use of antibiotics in children with intestinal flora imbalance, makes mold infested, that cause mould enteritis. Clinical characterized by severe diarrhea, several times a day to more than 10 times, rendering, yellow-green stool watery mucus, serious when can discharge blood stool, pediatric illnesses out mould enteritis, children are usually accompanied by low thermal, symptoms such as nausea, vomiting, abdominal pain, merthiolate-iodine-formaldehyde visible mold spores. Given anti-fungal drugs in parallel with montmorillonite powder, curative effect is reliable, efficient of more than 95%. Usage: within one year of age to give a third package, given half a pack 1 ~ 4 years old, 5 years of age or older to give 1 package, oral three times a day, even served 7 days or so.
7. Treatment of pediatric stomatitis: pediatric stomatitis and oral ulcer are available outside the montmorillonite powder paste on affected area, 3 times a day. Topical montmorillonite powder apply to cure stomatitis and oral ulcer, it has obvious analgesic effect, and can promote oral inflammation and ulcer recovery speed, good effect, can be applied as a conventional drugs.
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