酸相关疾病药物治疗专家共识

doi:10.12114/j.issn.1007-9572.2026.0063

摘要/Abstract

摘要： 酸相关疾病发病率高，且高负担特征明显。胃酸分泌过多或胃酸高敏感是酸相关疾病的共同发病机制，在药物治疗方面，"异病同治"现象较为普遍。随着质子泵抑制剂等抑酸药物不合理使用风险日益受到关注，迫切需要加深对酸相关疾病药物治疗的系统性认识，促进合理用药。本共识通过组织临床医学、药学和方法学等多学科专家，基于循证医学证据，在酸相关疾病分类、治疗药物、诊断方法、药学服务等方面进行系统性阐述，并就实践中面临的主要临床问题进行共识和处置推荐。本共识的发布对国内酸相关疾病药物治疗管理体系建立、促进合理用药具有重要意义。

关键词: 酸相关疾病, 药学服务, 药学治疗, 合理用药, 专家共识

Abstract:

Acid-related diseases are characterized by high incidence rates and significant disease burden. Excessive gastric acid secretion or heightened gastric acid sensitivity represents the common pathogenesis of these conditions, leading to the widespread application of the principle of "treating different diseases with the same therapy" in medication management. With growing concerns regarding the risks associated with inappropriate use of acid-suppressing drugs such as proton pump inhibitors, there is an urgent need to deepen the systematic understanding of medication therapy for acid-related diseases and to promote rational drug use. This consensus was developed by a multidisciplinary panel of experts in clinical medicine, pharmacy, and methodology. Based on evidence-based medicine, it provides a systematic elaboration on the classification of acid-related diseases, therapeutic drugs, diagnostic methods, and pharmaceutical care services. Additionally, it offers consensus recommendations and management strategies for key clinical issues encountered in practice. The release of this consensus is of great significance for establishing a medication therapy management system and promoting rational drug use for acid-related diseases.

Key words: Acid-related diseases, Pharmaceutical services, Medication therapy, Rational drug use, Expert consensus

中图分类号:

R 95

中国药理学会药源性疾病专委会. 酸相关疾病药物治疗专家共识[J]. 中国全科医学, 2026, 29(19): 2593-2607. DOI: 10.12114/j.issn.1007-9572.2026.0063.
China Pharmacological Society Committee on Drug-induced Diseases. Expert Consensus on Medication Therapy for Acid-related Diseases[J]. Chinese General Practice, 2026, 29(19): 2593-2607. DOI: 10.12114/j.issn.1007-9572.2026.0063.

图/表 6

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药物分类	子类别/代表药物	主要作用机制/特点
抑酸药	（1）H₂受体拮抗剂：西咪替丁、雷尼替丁、法莫替丁、罗沙替丁	阻断胃壁细胞H₂受体，减少胃酸分泌
	（2）PPIs：奥美拉唑、兰索拉唑、泮托拉唑、雷贝拉唑、艾普拉唑、艾司奥美拉唑	抑制H⁺/K⁺-ATP酶，强效抑酸
	（3）P-CAB：富马酸伏诺拉生、替戈拉生、盐酸凯普拉生、戊二酸利那拉生酯	钾离子竞争性酸阻滞剂，快速抑酸且不受进食影响
抗酸药	铝碳酸镁、氢氧化铝、磷酸铝凝胶	直接中和胃酸，快速缓解症状
胃黏膜保护剂	外源性：硫糖铝、铝碳酸镁、枸橼酸铋钾、胶体果胶铋	促进黏液分泌、增加碳酸氢盐含量，物理覆盖保护黏膜
胃黏膜保护剂	内源性：替普瑞酮、瑞巴派特、伊索拉定、依卡倍特钠、聚普瑞锌、胃肠激素类、谷氨酰胺类	稳定细胞膜、增加黏膜保护因子、促进血流、抗氧化，保护胃及小肠黏膜
促动力药	（1）多巴胺D₂受体拮抗剂：多潘立酮；（2）多巴胺D₂受体拮抗剂和乙酰胆碱酯酶抑制剂双重作用：伊托必利；（3）5-HT₄受体激动剂：莫沙必利、普芦卡必利；（4）5-HT₄受体和多巴胺受体双重作用：西尼比利、甲氧氯普胺；（5）阿片肽受体激动剂：曲美布汀；（6）胃动素受体激动剂：红霉素及其衍生物	增强胃肠蠕动、协调运动功能，改善消化不良及胃食管反流
消化酶制剂	胰酶、胃蛋白酶及其复方	补充消化酶，促进食物分解，缓解酶缺乏导致的腹胀、消化不良
TLESR抑制剂	巴氯芬	抑制一过性下食管括约肌松弛（TLESR），减少胃内容物反流
中成药	摩罗丹、枳术宽中胶囊、胃苏颗粒、达立通颗粒、加味左金丸、荜铃胃痛颗粒、荆花胃康胶丸、气滞胃痛颗粒、舒肝解郁胶囊、心胃止痛胶囊、香砂平胃颗粒、香砂养胃丸、香砂六君子颗粒等	调和脾胃、疏肝理气、活血止痛（注：具体机制因药方而异）
神经调节剂	氟哌噻吨美利曲辛、西酞普兰、度洛西汀、舍曲林、帕罗西汀、米氮平、曲唑酮、劳拉西泮等	调节中枢神经功能，改善焦虑抑郁情绪及伴随的胃肠症状
根除Hp抗菌药物	阿莫西林、克拉霉素、四环素、左氧氟沙星、甲硝唑、呋喃唑酮等	联合PPIs和铋剂，根除Hp
止吐药	（1）5-HT₃受体拮抗剂：昂丹司琼等；（2）神经激肽NK₁受体拮抗剂：阿瑞匹坦；（3）5-HT₄受体和多巴胺受体双重作用：甲氧氯普胺；（4）组胺H₁受体拮抗剂：异丙嗪；（5）毒蕈碱M受体拮抗剂：东莨菪碱	通过中枢或外周作用，单药或联合用于预防或治疗常见的急慢性恶心呕吐

药物分类	子类别/代表药物	主要作用机制/特点
抑酸药	（1）H₂受体拮抗剂：西咪替丁、雷尼替丁、法莫替丁、罗沙替丁	阻断胃壁细胞H₂受体，减少胃酸分泌
	（2）PPIs：奥美拉唑、兰索拉唑、泮托拉唑、雷贝拉唑、艾普拉唑、艾司奥美拉唑	抑制H⁺/K⁺-ATP酶，强效抑酸
	（3）P-CAB：富马酸伏诺拉生、替戈拉生、盐酸凯普拉生、戊二酸利那拉生酯	钾离子竞争性酸阻滞剂，快速抑酸且不受进食影响
抗酸药	铝碳酸镁、氢氧化铝、磷酸铝凝胶	直接中和胃酸，快速缓解症状
胃黏膜保护剂	外源性：硫糖铝、铝碳酸镁、枸橼酸铋钾、胶体果胶铋	促进黏液分泌、增加碳酸氢盐含量，物理覆盖保护黏膜
胃黏膜保护剂	内源性：替普瑞酮、瑞巴派特、伊索拉定、依卡倍特钠、聚普瑞锌、胃肠激素类、谷氨酰胺类	稳定细胞膜、增加黏膜保护因子、促进血流、抗氧化，保护胃及小肠黏膜
促动力药	（1）多巴胺D₂受体拮抗剂：多潘立酮；（2）多巴胺D₂受体拮抗剂和乙酰胆碱酯酶抑制剂双重作用：伊托必利；（3）5-HT₄受体激动剂：莫沙必利、普芦卡必利；（4）5-HT₄受体和多巴胺受体双重作用：西尼比利、甲氧氯普胺；（5）阿片肽受体激动剂：曲美布汀；（6）胃动素受体激动剂：红霉素及其衍生物	增强胃肠蠕动、协调运动功能，改善消化不良及胃食管反流
消化酶制剂	胰酶、胃蛋白酶及其复方	补充消化酶，促进食物分解，缓解酶缺乏导致的腹胀、消化不良
TLESR抑制剂	巴氯芬	抑制一过性下食管括约肌松弛（TLESR），减少胃内容物反流
中成药	摩罗丹、枳术宽中胶囊、胃苏颗粒、达立通颗粒、加味左金丸、荜铃胃痛颗粒、荆花胃康胶丸、气滞胃痛颗粒、舒肝解郁胶囊、心胃止痛胶囊、香砂平胃颗粒、香砂养胃丸、香砂六君子颗粒等	调和脾胃、疏肝理气、活血止痛（注：具体机制因药方而异）
神经调节剂	氟哌噻吨美利曲辛、西酞普兰、度洛西汀、舍曲林、帕罗西汀、米氮平、曲唑酮、劳拉西泮等	调节中枢神经功能，改善焦虑抑郁情绪及伴随的胃肠症状
根除Hp抗菌药物	阿莫西林、克拉霉素、四环素、左氧氟沙星、甲硝唑、呋喃唑酮等	联合PPIs和铋剂，根除Hp
止吐药	（1）5-HT₃受体拮抗剂：昂丹司琼等；（2）神经激肽NK₁受体拮抗剂：阿瑞匹坦；（3）5-HT₄受体和多巴胺受体双重作用：甲氧氯普胺；（4）组胺H₁受体拮抗剂：异丙嗪；（5）毒蕈碱M受体拮抗剂：东莨菪碱	通过中枢或外周作用，单药或联合用于预防或治疗常见的急慢性恶心呕吐

指标类别	一级药学监护	二级药学监护	三级药学监护^a
病理生理状态
特殊生理状态	符合以下任意一项，进行一级药学监护：（1）妊娠或哺乳期女性；（2）新生儿或婴幼儿（≤3岁）	符合以下任意一项，进行二级药学监护：（1）儿童（>3岁，≤18岁）或老年（≥65岁）；（2）吞咽困难或禁食状态	体质量异常^[26]（BMI<18.5 kg/m²或BMI≥28.0 kg/m²）
特殊病理状态	符合以下任意一项，进行一级药学监护：（1）重度感染；（2）呕血、血便或活动性出血；（3）循环衰竭、呼吸衰竭、意识障碍、误吸或GBS评分>1分中任意一项；（4）肝硬化或重度肝、肾功能不全^b；（5）合并严重创伤、手术等应激状态^c；（6）ICU等重症科室转诊患者	符合以下任意一项，进行二级药学监护：（1）合并其他基础疾病，病情不稳定（例如GERD洛杉矶分级C~D级）；（2）中度感染；（3）接受全肠外营养支持或管饲肠内营养支持；（4）营养风险筛查（NRS-2002）≥3分；（5）黑便或内镜下观察到少量出血；（6）凝血功能障碍（INR>1.5）；（7）中度肝、肾功能不全；（8）合并睡眠障碍或需要精神心理治疗干预；（9）既往Hp根除失败	（1）轻度感染；（2）粪便隐血阳性；（3）轻度肝、肾功能不全
药物治疗情况
酸相关疾病用药风险	符合以下任意一项，进行一级药学监护：（1）用药品种数^[23]≥10种；（2）抑酸剂或抗酸剂使用双倍以上治疗剂量；（3）发生有临床意义的药物相互作用；（4）有药物不良反应，CTCAE 4~5级	符合以下任意一项，进行二级药学监护：（1）5种≤用药品种数^[23] <10种；（2）存在相似作用机制药物的联合使用；（3）抑酸剂或抗酸剂使用双倍治疗剂量；（4）有药物不良反应，CTCAE 2~3级；（5）长期使用或住院期间合并使用糖皮质激素、非甾体抗炎药、抗血小板药物、双膦酸盐、免疫抑制剂、化疗药等对消化道黏膜屏障破坏作用的药物	（1）仅有潜在的药物相互作用；（2）药物不良反应轻微，如CTCAE 1级
合理用药管控	参考所在医疗机构相关管控指标^d

指标类别	一级药学监护	二级药学监护	三级药学监护^a
病理生理状态
特殊生理状态	符合以下任意一项，进行一级药学监护：（1）妊娠或哺乳期女性；（2）新生儿或婴幼儿（≤3岁）	符合以下任意一项，进行二级药学监护：（1）儿童（>3岁，≤18岁）或老年（≥65岁）；（2）吞咽困难或禁食状态	体质量异常^[26]（BMI<18.5 kg/m²或BMI≥28.0 kg/m²）
特殊病理状态	符合以下任意一项，进行一级药学监护：（1）重度感染；（2）呕血、血便或活动性出血；（3）循环衰竭、呼吸衰竭、意识障碍、误吸或GBS评分>1分中任意一项；（4）肝硬化或重度肝、肾功能不全^b；（5）合并严重创伤、手术等应激状态^c；（6）ICU等重症科室转诊患者	符合以下任意一项，进行二级药学监护：（1）合并其他基础疾病，病情不稳定（例如GERD洛杉矶分级C~D级）；（2）中度感染；（3）接受全肠外营养支持或管饲肠内营养支持；（4）营养风险筛查（NRS-2002）≥3分；（5）黑便或内镜下观察到少量出血；（6）凝血功能障碍（INR>1.5）；（7）中度肝、肾功能不全；（8）合并睡眠障碍或需要精神心理治疗干预；（9）既往Hp根除失败	（1）轻度感染；（2）粪便隐血阳性；（3）轻度肝、肾功能不全
药物治疗情况
酸相关疾病用药风险	符合以下任意一项，进行一级药学监护：（1）用药品种数^[23]≥10种；（2）抑酸剂或抗酸剂使用双倍以上治疗剂量；（3）发生有临床意义的药物相互作用；（4）有药物不良反应，CTCAE 4~5级	符合以下任意一项，进行二级药学监护：（1）5种≤用药品种数^[23] <10种；（2）存在相似作用机制药物的联合使用；（3）抑酸剂或抗酸剂使用双倍治疗剂量；（4）有药物不良反应，CTCAE 2~3级；（5）长期使用或住院期间合并使用糖皮质激素、非甾体抗炎药、抗血小板药物、双膦酸盐、免疫抑制剂、化疗药等对消化道黏膜屏障破坏作用的药物	（1）仅有潜在的药物相互作用；（2）药物不良反应轻微，如CTCAE 1级
合理用药管控	参考所在医疗机构相关管控指标^d

监护项目	条目	一级监护	二级监护	三级监护
药学问诊	时间	入院/转诊或病情变化时
药学查房/过程监护	频次	≥3次/周	≥2次/周	≥1次/周
药学查房/过程监护	项目	医嘱审核用药干预病例讨论/会诊	医嘱审核用药干预	医嘱审核
用药咨询/用药教育	时间	出院前/必要时