摘要肺部疾病的高发病率与肺功能损伤对人类健康构成重大威胁。传统呼吸支持技术难以有效逆转组织缺氧及肺损伤进程，而肠道气体灌注疗法为呼吸治疗提供了新思路。啮齿类及大型哺乳动物经直肠氧气灌注可显著提升血氧饱和度，其机制涉及肠道黏膜血管生成增强和静脉系统氧输送。临床观察发现，新型冠状病毒肺炎患者接受直肠臭氧（O 3）灌注治疗后，氧合指标快速改善，炎症标志物显著下降。O 3作用机制可能包括活性氧信号激活核转录因子红系2相关因子2（Nrf2）抗氧化通路，调节肠道菌群介导的肠-肺轴免疫调控，以及改善红细胞氧释放能力。直肠O 3灌注技术具有操作简便、经济安全的特点，在呼吸支持设备短缺时尤具应用潜力。现有证据提示，肠道可能通过气体交换与全身氧合调节发挥"第二肺"功能；直肠O 3灌注为急慢性呼吸衰竭及肺部炎症性疾病治疗开辟新路径，但需进一步验证其长期安全性与分子机制。

abstractsThe high incidence of pulmonary diseases and associated functional impairments pose significant threats to global health. Conventional respiratory support techniques often fail to effectively reverse tissue hypoxia or mitigate lung injury progression, while intestinal gas insufflation therapy offers a novel therapeutic approach. Preclinical studies in rodents and large mammals demonstrate that rectal oxygen insufflation significantly enhances blood oxygen saturation, through intestinal mucosal angiogenesis and venous oxygen delivery. Clinical observations in COVID-19 patients reveal rapid improvement in oxygenation indices and obvious reductions in inflammatory markers following rectal ozone (O 3) insufflation. Mechanistically, O 3 may exert therapeutic effects via reactive oxygen species-triggered activation of the nuclear factor erythroid-2 related factor 2 (Nrf2) antioxidant pathway, gut microbiota-mediated immunomodulation through the gut-lung axis, and enhanced erythrocyte oxygen release capacity. Rectal O 3 insufflation, characterized by procedural simplicity, cost-effectiveness, and safety, holds promise as an alternative respiratory support strategy under resource-limited settings. Emerging evidence suggests the intestine may function as a "secondary lung" by facilitating gas exchange and systemic oxygenation regulation. This therapy opens new avenues for managing acute/chronic respiratory failure and inflammatory lung diseases, though further validation of its long-term safety and molecular mechanisms remains imperative.