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慎用利巴韦林!手足口病临床3型常用中成药用药指导-
慎用利巴韦林!手足口病临床3型常用中成药用药指导

慎用利巴韦林!手足口病临床3型常用中成药用药指导

儿童手足口病的临床分型、主要临床表现、常用中成药及用药指导:

(一)邪犯肺脾证

【主要临床表现】发热轻微,或无发热,或流涕咳嗽,口腔、手掌、足跖部疱疹,分布稀疏,疹色红润.疱液清亮、

【常用中成药】疏风解毒胶囊,蒲地蓝消炎口服液,双黄连口服液,蓝芩口服液,小儿热速清口服液,小儿豉翘清热颗粒,清热解毒口服液等。

【用药指导】该证型属于手足口病初起,上述药物均可选用。双黄连口服液、蓝芩口服液、蒲地蓝消炎口服液用于初起轻度发热咽痛明显者;小儿热速清口服液和小儿豉翘清热颗粒用于发热咽痛,尤其对于手足口病初起大便干结者可优先选用;清热解毒口服液用于病初即发热较高的患儿

慎用利巴韦林!手足口病临床3型常用中成药用药指导

(二)心脾积热证

【主要临床表现】心烦躁扰,口舌干燥,疼痛拒食,小便黄赤,大便干结,手掌、足跖、口腔疱疹,分布稀疏,疹色红润,疱液清亮

【常用中成药】健儿清解液,小儿化毒散,导赤丸等。

【用药指导】该证为手足口病轻症,但口部疱疹较甚,进食较困难,大便干结。健儿清解液主要用于手足口病口部疱疹较甚,进食较困难的患儿;小儿化毒散主要用于手足口病咽部症状明显的患儿;导赤丸用于手足口病热盛,大便干结的患儿。

慎用利巴韦林!手足口病临床3型常用中成药用药指导

(三)湿热蒸盛证

【主要临床表现】高热,口臭,大便千结,手、足、口部及四肢、臀部疱疹,全身症状明冠,

【常用中成药】清胃黄连丸,黄栀花口服液,清开灵口服液等。

【用药指导】该证型多见于手足口病重症,年幼儿及感邪较重者。清胃黄连丸主要用于手足口病高热,口臭的患儿;黄栀花口服液用于大便干结者,其内含大黄,素体脾胃虚寒、脾胃虚弱及大便次数多患儿慎用。清开灵口服液用于手足口病较重,手、足、口部及四肢、臀部疱疹,全身症状明显的患儿。

慎用利巴韦林!手足口病临床3型常用中成药用药指导

家长课堂:慎用利巴韦林

利巴韦林在国外主要用于慢性丙肝和流行性出血热的抗病毒药,在我国却被广泛应用于各种病毒感染,尤其是在治疗儿童手足口病时作为常用口服药。而美国食品与药品监督管理局(FDA) 目前只批准利巴韦林口服和气雾剂,静脉用药还在试验阶段。而雾化剂只允许用于治疗重度下呼吸道感染。口服剂用于治疗病毒性出血热,以及与干扰素 α—2b 联用,治疗慢性丙肝。 实际上,虽然利巴韦林的体外试验对呼吸道合胞病毒具有选择性抑制作用,但其治疗腺病毒、呼吸道合胞病毒、副流感病毒或流感病毒感染临床效果目前并不确定。而且,不可忽视利巴韦林的副作用:

1. 最主要毒性:溶血性贫血

利巴韦林最主要的毒性是溶血性贫血。有报道显示,贫血患者服用利巴韦林可引起心肌损害,有些是致命的,故具有心脏病史或明显心脏病症状患者不可使用利巴韦林。所以,使用利巴韦林治疗前后及治疗中应频繁监测血红蛋白。

2. 可怕的风险:致畸性和致癌性

虽然还没有利巴韦林对人类的致畸、致癌的权威研究结论,但 WHO 有一项长达 19 年的药物不良反应监测报告显示,可能由于使用利巴韦林而引起机体不良反应的 6 649 例报告中,有 52 例是肿瘤,有 96 例是胎儿异常,这个比例真的不算小了。而且,动物实验显示利巴韦林有明显的致畸性和致癌性。

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