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宝宝发烧别着急，专家推荐安全的退烧药

发布日期：2024-09-11 06:39:01编辑：胖虎爱撩妹

 
对乙酰氨基酚和布洛芬
 
如果物理降温没有效果，对于腋下温度超过38.5℃的宝宝，还是要使用退烧药。使用退烧药的目的主要有两点：其一是缓解发烧给宝宝带来的不适，以便宝宝能正常饮食和睡觉，为对抗疾病补充足够的能量和保持体力；其二是预防宝宝可能因为高烧引起的高热惊厥。提示一点：有过一两次高热惊厥通常不会对宝宝大脑发育造成影响，家长们不必过于担心。但反复高热惊厥对宝宝大脑多少会造成一些损伤，一部分会转变为复杂型高热惊厥或者癫痫，应该尽量避免。因此有过高热惊厥史的宝宝在体温达到38℃时就可以考虑药物降温。另外，降温是为了避免引发高热惊厥，因此使用退烧药降温的目的不是要把体温降到平时的正常温度，而是降低到38.5℃以下就可以了。
 
世界各国广泛使用的经世界卫生组织推荐的老少皆宜、经济实惠、使用安全性高的退烧药是两种经典口服药：对乙酰氨基酚和布洛芬。
 
对乙酰氨基酚是首选，适用于3个月以上的儿童和成人
 
这个药名比较拗口，大家可能会不太熟悉，但说起扑热息痛、必理通或者泰诺林这样的药名大家应该就不陌生了，它们是同一种药的不同名字，好比一个人身份证上的名字与这个人的各种绰号的关系一样。它们都是含单一有效成分“对乙酰氨基酚”的退烧药。
 
儿童服用对乙酰氨基酚的日常每次最大剂量为每千克体重15毫克，每4小时一次，一天最多4次。举例来说，如果宝宝体重10千克，则每次能给的最大剂量是150毫克，如果你手里的对乙酰氨基酚的浓度是每毫升含100毫克的滴剂，那150毫克药量折算成喂药的体积便是1.5毫升，也就是说，一个10千克重的宝宝每次最大剂量可以服用1.5毫升，低于这个剂量的用量都是安全的，但不能超过。对乙酰氨基酚成人常规推荐剂量为每次500毫克或650毫克，每4～6小时一次，一天最多4次，单次最大剂量1000毫克，一天最大剂量4000毫克。对乙酰氨基酚孕期和哺乳期的女性都可以使用，不会伤害胎儿，也不会影响到哺乳中的宝宝。
 
对乙酰氨基酚合理剂量下使用安全性高，但超过最大剂量服用会造成肝损伤。常用的复方感冒药中，往往含有“对乙酰氨基酚”这个成分，如儿童用的氨酚烷胺颗粒、氨酚黄那敏颗粒、氨酚麻美糖浆、酚麻美敏混悬液，以及成人用的日夜百服咛、白加黑感冒片等。如果服用单一成分的对乙酰氨基酚退烧的同时，也在服用上述复方感冒药，就很容易因为重复用药导致对乙酰氨基酚过量，因此服药前要仔细核对药物成分，避免含相同有效成分药品叠加服用。
 
对乙酰氨基酚除了有液体剂型外，还有另外一种剂型：通过肛门给药的剂型，即栓剂。在国外，肛门给药实际上很普遍，不过由于我们国家文化的原因，绝大多数中国人对这种用药方式接受起来还比较困难。但对于有些情况，比如给宝宝喂药时，宝宝会呕吐，或者宝宝夜里发高烧，不想把宝宝叫醒，这些时候用肛门栓就会方便很多。
 
栓剂的吸收不经过肝脏，也不刺激胃肠道，比口服的方式起效要快，因为药物直接就从肠道黏膜进入血液了。但是，从吸收率角度来讲，口服吸收率高，栓剂通过黏膜对药物进行吸收，吸收率就低一点。所以，一般口服的最大剂量是每千克体重每次15毫克，用栓剂的时候，用的剂量就要相应大一点，每千克体重每次最大剂量可以用到20毫克。
 
我在药房里给病人发栓剂的时候，曾经有患者不好意思地问我：“用了药栓什么时候把它拿出来？”这虽然是个好笑的问题，但从另一个角度也说明了很多中国人对这一剂型的陌生，病人觉得有个东西放进肛门里，就应该过一段时间再把它取出来。实际上，栓剂放进去后，就不用管它了，因为它自己会溶化，释放出药物发挥作用，剩下的辅料直接被身体吸收了。顺便透露个小秘密，栓剂最初的生产灵感可是来源于巧克力，大家都知道，可可豆脂是巧克力的组成部分，在体温下能迅速溶化，对黏膜的刺激性很小，可塑性也好，因此也是一种优良的药用辅料，常常用来制作栓剂。
 
因为中国人比较难以接受这个方式给药，所以栓剂在中国用得不多，有一些家长以为中国没有退热栓剂，所以会到网上海淘。海外的卖家会说，这个退热栓更好，你淘这个，有的家长就淘回来了。其实这样做是有风险的，因为海淘回来的药，说明书是用当地的语言写的，很容易误用。我认识一位妈妈，她在网上淘了一盒对乙酰氨基酚栓，买来后放在家里的药箱里。有一次她不在家，家里的老人刚好发现宝宝有点便秘了，就给宝宝用了。因为老人看不懂说明书，在惯性思维下，以为栓剂就是通便的，结果用错药了。所以再次提醒家长们，对乙酰氨基酚的栓剂国内其实是有的，可以在药店买到，不必海淘。
 
布洛芬适用于6个月以上的儿童和成人
 
蚕豆病即遗传性葡萄糖-6-磷酸脱氢酶（G6PD）缺乏症患者退烧时，应避免使用对乙酰氨基酚，但是可以使用布洛芬。使用对乙酰氨基酚退烧无效的患者，也可以考虑使用布洛芬退烧。人们熟知的以布洛芬为单一有效成分的药包括美林、芬必得等。
 
儿童服用布洛芬的日常最大用量为每次每千克体重10毫克，每6小时一次，一天最多4次。成人常规用量为每次200～400毫克，每6～8小时一次，一天最多4次，一天最大剂量2400毫克。不超过最大剂量使用都是安全的。
 
布洛芬退烧作用比较强，退烧过程中会导致人体大量出汗，因此布洛芬退烧不适用于有脱水症状的患者。同时，布洛芬通过肾脏排泄，肾脏功能不好的患者也要谨慎使用。布洛芬不良反应还包括可能会诱发哮喘，有哮喘的宝宝应慎用。这种药按照推荐剂量使用安全，但过量容易造成肾损伤。
 
持续高烧不退，可以考虑对乙酰氨基酚和布洛芬交替使用
 
对乙酰氨基酚最小给药时间间隔是4小时，当对乙酰氨基酚用了最大剂量后两小时烧还没退下来，这时只能交替使用布洛芬，因为这两种药交替使用的最小时间间隔是两小时。交替使用时，两药各自每天最多使用的次数不变。
 
需要注意的是，当一天只需服用两三次退烧药就能退烧时，我建议选择单一退烧药，因为每增加一种药品，就会使得吃错药的风险增加一倍。因此用一种退烧药就能控制发烧时，不要交替使用两种。另外，吃药退烧时要多喝水，加快排泄进程有利于带走体内热量。同时，吃药降温的同时也需要配合物理降温，像洗温水澡或温湿毛巾擦拭全身，但不要使用酒精擦拭，尤其是儿童，酒精容易透过儿童稚嫩的皮肤导致其酒精中毒。

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