儿科用药的6个关键

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                    <p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　<span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 36px; color: rgb(255, 0, 0); box-sizing: border-box !important; word-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">儿</strong></span>童患者是一个特别需要关爱的群体。作为中国花朵和家庭未来的儿童患者，因为其本身尚在发育的特点，其用药有区别于成人的特殊性。</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　</span></p><p style=""><strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; color: rgb(255, 0, 0); box-sizing: border-box !important; word-wrap: break-word !important;">　　一、给药途径的选择</span></strong></p><p style=""><strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; color: rgb(255, 0, 0); box-sizing: border-box !important; word-wrap: break-word !important;">　　</span></strong></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　为了给药的安全有效，应区分不同情况，选用不同给药方式。原则上能口服解决的，尽量口服给药。对于口服药物困难，病情严重或者病情发展迅速的患者，要果断采取静脉给药或其他肠道外给药。所以家长由于心急，经常会自己要求医生打针挂瓶，认为这样孩子病好得快点，这是一个误区。另外必须注意的儿科患者禁用含苯甲醇的制剂肌注，因其反复肌注可能导致臀肌挛缩症。</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　<span style="margin: 0px; padding: 0px; max-width: 100%; color: rgb(255, 0, 0); box-sizing: border-box !important; word-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">二、口服剂型的合理使用</strong></span></span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　考虑儿科患者对药物的接受问题，儿科剂型一般更多选用糖浆剂，颗粒剂，口服液，干混悬剂，泡腾剂，分散片，滴剂等等。林林总总的小患者用药总是包装得花花绿绿，口感也经常是酸酸甜甜好味道。曾经有天值班，听到一个稚嫩的声音说：“妈妈，阿姨又给我好吃的口服液了，还有漂亮的盒盒。”孩子的母亲说，孩子一到医院就要医生开他爱吃的口服液，这是把药当零食的节奏啦！可见儿科用药口感和包装很重要，只有喂得进去的药才可能治好病呢！</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　值得注意的是干混悬剂和颗粒剂通常只适合用温开水泡服，一般水量控制在3到10毫升左右，避免冲淡调味剂，并可以减少喂药难度。抗生素服完，一定注意喂几口开水，避免局部药物浓度过高，导致鹅口疮。泡腾片和分散片注意用温开水溶化后服用。泡腾片严禁直接服用，因为泡腾片遇水产生大量二氧化碳，直接呑服可以造成患儿窒息。俗称鱼肝油的维生素AD滴剂等软胶囊，要将胶囊弄破后，滴入孩子口中。口服液如果不是整支服用，要将铝盖打开，用汤匙倒取处方剂量。由于婴幼儿缺乏吞咽能力，片剂一般先按处方剂量用剪刀分好后，用适量开水溶化后服用，某些味道欠佳的药物可以加入白糖调味。</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　<strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; color: rgb(255, 0, 0); box-sizing: border-box !important; word-wrap: break-word !important;">三、合理的喂药方式和送服液体</span></strong></span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　给年龄较小的患儿喂药时，妈妈坐位，用毯子或大浴巾裹束孩子的胳膊和腿，左胳膊枕着孩子的脖子，托住头，成半卧位，手臂顺势搂着孩子的身子。右手持勺喂药。孩子不愿服药时，可以用拇指和食指按压小儿双颊，使口张开，用小勺或滴管慢慢将药液从嘴角灌入，每次少量服用，吞咽后再继续喂服。大点的孩子可以跟他沟通，让他明白良药苦口利于病，自己主动服药。一般药物只能用开水送服，应避免用牛奶或果汁送服。</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　<span style="margin: 0px; padding: 0px; max-width: 100%; color: rgb(255, 0, 0); box-sizing: border-box !important; word-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">四、说明书的合理研读</strong></span></span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　由于用儿童志愿者做实验有违伦理道德，一般药品说明书对儿童用药问题的表述总是过于简单，经常使用“尚不明确”字样。一般如果没有明确标注“儿童禁用”字样，家长不必过于担心。</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　但确实有些药物是儿童严禁使用的，比如：氟哌酸、左氧氟沙星等氟喹诺酮类由于可能造成幼年动物骨关节损害，禁用于18岁以下儿童；庆大霉素、妥布霉素等氨基糖苷类由于耳肾毒性禁用于6岁以下儿童；退烧药尼美舒利因可引起瑞氏综合征，造成儿童肝脏和中枢神经系统损伤，禁用于12岁以下儿童。同样阿司匹林也可能引起瑞氏综合症，一般作为退烧药时避免选择，仅适用于川崎病的治疗。四环素可能造成肝胀损害，影响骨牙生长，并可能引起血液系统不良反应，禁用于8岁以下幼儿。氯霉素可能造成灰婴综合征禁用于出生早产儿和出生两周内的新生儿，由于可能造成血液系统严重不良反应，一般不主张用于儿童患者。总之儿童用药除了疗效，应从孩子生长发育的角度出发，更多地考虑安全性问题。</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　<span style="margin: 0px; padding: 0px; max-width: 100%; color: rgb(255, 0, 0); box-sizing: border-box !important; word-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;">　五、分剂量的问题</strong></span></span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　儿童作为一个尚未成熟的个体，体重轻，肝肾功能发育不全。一般用药量低于成人，经常使用非整片或非整包装的药品，应该注意分剂量问题，片剂用清洗干净的剪刀分剪均匀，尤其注意一天总剂量要保证准确。口服液用量杯量取，注意看刻度时量杯放置水平桌面，视线要平视刻度。</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; color: rgb(255, 0, 0); box-sizing: border-box !important; word-wrap: break-word !important;"><strong style="margin: 0px; padding: 0px; max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　六、关于误服药物和发生药物呕吐处理</span></strong></span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　</span></p><p style=""><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 18px; box-sizing: border-box !important; word-wrap: break-word !important;">　　一旦儿童误服药物要尽快上医院看医生，医生会根据情况给予不同的处理。影响较大的药物过量服用时，一般误服时间在四小时以内的医生会给予洗胃，超过四小时的会给予导泄，另外可能输液促进药物排泄，给予针对性的拮抗剂等等。对于服药后即呕吐的，一般并未吸收，可给予补服一次药物。服药数小时后呕吐的，由于无法判断吸收剂量，一般不能补服，以免超量服用。</span></p><p style="margin-top: 0px; margin-bottom: 0px; padding: 0px; max-width: 100%; min-height: 1em; white-space: pre-wrap; color: rgb(62, 62, 62); line-height: 24px; font-family: Arial, Verdana, sans-serif; font-size: 12px; background-color: rgb(249, 249, 249); box-sizing: border-box !important; word-wrap: break-word !important;"><span style="margin: 0px; padding: 0px; max-width: 100%; font-size: 14px; box-sizing: border-box !important; word-wrap: break-word !important;">广州市设备维修有限公司<br style="margin: 0px; padding: 0px; max-width: 100%; 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