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                您當前位置:網站首頁 >> 醫藥新聞 >> 行業動態 >> 丁香播報:布洛芬和對乙酰氨基酚 你可能不知道的事
               
               
              丁香播報:布洛芬和對乙酰氨基酚 你可能不知道的事
              2019-03-26 17:31:17 來源:丁香園 瀏覽:5102


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              丁香播報2017年第四期


              本期主播:丁香園 ?李彥昕

              作者:汗哥?《布洛芬和對乙酰氨基酚 你可能不知道的事》

              布洛芬和對乙酰氨基酚作為退熱藥,是目前應用最普遍也是目前認為最適合兒童使用的退熱藥,可是,您真的了解這兩個藥嗎?下列 5 個問題來看一下。

              布洛芬和對乙酰氨基酚屬于同一種類型的退熱藥嗎?

              布洛芬(Ibuprofen),和萘普生一樣屬于芳基丙酸類解熱鎮痛藥,有明顯的抗炎、解熱、鎮痛作用,強度與阿司匹林相當,對血小板功能有一定的抑制作用,可延長出血時間,但在常規治療劑量使用時,不良反應發生率低,耐受性與對乙酰氨基酚相似。

              對乙酰氨基酚(Acetaminophen、Paracetamol),又稱醋氨酚、撲熱息痛,Panadol、Tylenol、Fortolin 等都是這類藥物,為苯胺類解熱鎮痛藥,其解熱、鎮痛作用強度與阿司匹林類似,但抗炎作用極弱(可能與藥物對機體不同酶的敏感性差異有關),對凝血機制無影響。對乙酰氨基酚毒副作用少,較易耐受,是一種比較安全的退熱藥,很多復方制劑的感冒藥里都有它的存在。

              布洛芬和對乙酰氨基酚的退熱效果有什么不同嗎?

              布洛芬和對乙酰氨基酚都屬于非甾體類解熱鎮痛藥,通過抑制前列腺素的合成從而發揮解熱、鎮痛的作用,從而達到使發熱者退熱、緩解疼痛帶來的不適感等作用,但對體溫正常者是無影響的,不會使其體溫降低。兩者的退熱效果是相似的,但也存在一定的差異性。相對而言,單次劑量的布洛芬退熱作用相對較強,降溫維持時間相對較長,但對乙酰氨基酚體溫下降的速度在口服后半小時比布洛芬更明顯。

              布洛芬和對乙酰氨基酚作為兒童退熱藥安全嗎??

              沒有一種退熱藥是絕對安全的,而且都有過敏的可能。但總的來說,布洛芬和對乙酰氨基酚的副作用較輕微,在兒童中應用是較為安全的。兒童對布洛芬和對乙酰氨基酚耐受性都是差不多的,其不良反應的發生也與年齡無關,如果沒有禁忌證,布洛芬和對乙酰氨基酚都可作為患兒退熱藥的首選。

              布洛芬和對乙酰氨基酚在臨床上應用非常廣泛,兒科醫生和家長都應該重視其不良反應,不要隨意使用,如實需使用時,應根據患兒的年齡、體重來綜合計算(其中體重是優先考慮的)具體的給藥量,應避免用藥過量和用藥過頻。

              布洛芬和對乙酰氨基酚的副作用有什么不同嗎?

              1. 布洛芬的副作用

              主要為消化道的不良反應(發生率為 5%~15%),與食物同服,可減輕其胃腸道刺激。

              這些不良反應包括消化不良、胃灼熱感、上腹部疼痛、惡心、嘔吐、飽腹感等,一般都較輕微。另外,出現胃潰瘍和消化道出血者不足 1%,出現頭痛、嗜睡、眩暈、耳鳴等神經系統不良反應者約 1%~3%。其他少見的不良反應有下肢水腫、腎功能不全、皮疹、支氣管哮喘、肝功能異常、白細胞減少等。

              2. 對乙酰氨基酚的不良反應

              主要是反復多次的應用,超劑量所致,同時由于混合了病毒感染的因素,易引起肝炎。

              如使用對乙酰氨基酚的常規治療劑量僅偶見惡心、嘔吐、出汗、腹痛等不良反應,少數可發生過敏性皮炎 / 皮疹、粒細胞缺乏、血小板減少等。但若治療劑量的反復多次使用,尤其是高劑量長期用藥,可引起肝轉氨酶增高,但未見肝功能衰竭和死亡的報道;超劑量使用可導致肝功能明顯異常,有造成肝功能衰竭甚至死亡的報道。

              使用布洛芬和對乙酰氨基酚時有什么需要特別注意的?

              布洛芬與阿司匹林有交叉過敏,故對阿司匹林過敏的患兒禁用。有消化性潰瘍史、胃腸道出血、心功能不全、肝腎功能不全、高血壓、凝血機制或血小板功能障礙(如血友病)的患兒需慎用。脫水或水分補充不夠等低血容量的患兒使用布洛芬退熱可增加腎功能損害的風險。另外,罹患水痘的患兒使用布洛芬則可增加 A 組鏈球菌感染的風險。

              對阿司匹林過敏者對對乙酰氨基酚通常不發生過敏,但<5% 的阿司匹林過敏的患兒服用對乙酰氨基酚后可能會發生輕度支氣管痙攣性反應。服用劑量不應超過推薦劑量,否則可能引起頭痛、嘔吐、倦怠低血壓及皮疹等。嚴重肝腎功能不全者禁用。肝病或病毒性肝炎、輕至中度肝腎功能不全者、嚴重心肺疾病患兒應慎用。如果患兒出現黃疸癥狀需立即進行肝功能測試。

              如果伴有持續的嘔吐、腹瀉或液體攝入不足,出現明顯的脫水者需及時處理,積極糾正水及電解質平衡。如患兒出現囟門下陷、口唇干燥、眼眶下陷、少淚、虛弱等時意味著已經脫水了。若發現患兒具有脫水征時應注意補液,對于正處于哺乳期的患兒來說,最合適的液體就是母乳。

              參考文獻

              [1] https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682159.html

              [2] https://www.nlm.nih.gov/medlineplus/druginfo/meds/a681004.html

              [3] http://www.nice.org.uk/guidance/CG47 ?Feverish illness in children : Assessment and initial management in children younger than 5 years(NICE clinical guideline 160)

              [4] http://www.nice.org.uk/guidance/cg160/evidence/evidence-update-189987085 Evidence Update 73 – Feverish illness in children (February 2015).

              [5] 羅雙紅,舒敏,溫楊,等. 中國 0 至 5 歲兒童病因不明急性發熱診斷和處理若干問題循證指南 (標準版). 中國循證兒科雜志 [J], 2016,11(2):81-96.

              [6] 陸權. 中國兒童普通感冒規范診治專家共識(2013 年). 中國實用兒科雜志 [J],2013,28(9):680-686.

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