AAP儿童发热与退热药物(中英对照版)

FeverandAntipyreticUseinChildren儿童发热和退热药物应用Abstract摘要Feverinachildisoneofthemostcommonclinicalsymptomsmanagedbypediatriciansandotherhealthcareprovidersandafrequentcauseofparentalconcern.Manyparentsadministerantipyreticsevenwhenthereisminimalornofever,becausetheyareconcernedthatthechildmustmaintaina“normal”temperature.Fever,however,isnottheprimaryillnessbutisaphysiologicmechanismthathasbeneficialeffectsinfightinginfection.Thereisnoevidencethatfeveritselfworsensthecourseofanillnessorthatitcauseslong-termneurologiccomplications.Thus,theprimarygoaloftreatingthefebrilechildshouldbetoimprovethechild’soverallcomfortratherthanfocusonthenormalizationofbodytemperature.Whencounselingtheparentsorcaregiversofafebrilechild,thegeneralwell-beingofthechild,theimportanceofmonitoringactivity,observingforsignsofseriousillness,encouragingappropriatefluidintake,andthesafestorageofantipyreticsshouldbeemphasized.Currentevidencesuggeststhatthereisnosubstantialdifferenceinthesafetyandeffectivenessofacetaminophenandibuprofeninthecareofagenerallyhealthychildwithfever.Thereisevidencethatcombiningthese2productsismoreeffectivethantheuseofasingleagentalone;however,thereareconcernsthatcombinedtreatmentmaybemorecomplicatedandcontributetotheunsafeuseofthesedrugs.Pediatriciansshouldalsopromotepatientsafetybyadvocatingforsimplifiedformulations,dosinginstructions,anddosingdevices.Pediatrics2011;127:580–587儿童发热是儿科医生及医护人员常遇见的临床症状，同时也是引发家长焦虑的常见原因。许多患儿家长会在孩子轻微发热甚至无发热的情况下使用退热药，因为他们认为孩子的体温必须正常。发热并非一种疾病，它是机体对抗感染的一种生理机制。目前并无证据显示发热是某种疾病的导因或会导致神经系统并发症。因此，对发热患儿的首要任务并非将体温降至正常水平而是让孩子感到舒服。在给家长或护理人给予建议时，重点强调孩子的正常精神状态表现，观察活动程度的重要性，关注严重疾病的症状，鼓励适当的液体摄入以及退热药物的安全剂量。目前的证据显示，在安全性和效果方面，用于一般发热儿童的护理的对乙酰氨基酚和布洛芬并没有显著差异。有证据显示使用2种药物比单一使用某种更加有效；但是使用两种药物较为复杂同时易引发用药不安全事件的发生。儿科医生同时需要通过单一剂型、严格控制剂量和喂服药物器械上保证患儿安全。INTRODUCTION简介Feverisoneofthemostcommonclinicalsymptomsmanagedbypediatriciansandotherhealthcareprovidersandaccounts,bysomeestimates,forone-thirdofallpresentingconditionsinchildren.1Feverinachildcommonlyleadstounscheduledphysicianvisits,telephonecallsbyparentstotheirchild’sphysicianforadviceonfevercontrol,andthewideuseofover-the-counterantipyretics.儿童发热是儿科医生及医护人员常遇见的临床症状，据估算，有将近三分之一的就诊儿童均有此症状。儿童发热通常会导致无预约的就诊，电话咨询关于发热控制的建议以及超剂量的退热药物使用。Parentsarefrequentlyconcernedwiththeneedtomaintaina“normal”temperatureintheirillchild.Manyparentsadministerantipyreticseventhoughthereiseitherminimalornofever.2Approximatelyonehalfofparentsconsideratemperatureoflessthan38°C(100.4°F)tobeafever,and25%ofcaregiverswouldgiveantipyreticsfortemperaturesoflessthan37.8°C(100°F).1,3Furthermore,85%ofparents(n=340)reportedawakeningtheirchildfromsleeptogiveantipyretics.1Unfortunately,asmanyasone-halfofparentsadministerincorrectdosesofantipyretics;approximately15%ofparentsgivesupratherapeuticdosesofacetaminophenoribuprofen.4Caregiverswhounderstandthatdosingshouldbebasedonweightratherthanageorheightoffeveraremuchlesslikelytogiveanincorrectdose.4家长通常都有一种要求——保持患儿的体温“正常”。许多家长在低热甚至无发热状态下给孩子以退热药物。大约有一半的家长认为38℃以下也算发热，同时有25%的护理人会在体温低于37.8℃时给予退热药物。更甚，85%的家长（统计总数为340）有叫醒睡眠中的孩子服用退烧药的经历。不幸的是，有一半以上的家长都给予了孩子不恰当剂量的退热药物；大约15%的家长会给予孩子超剂量的对乙酰氨基酚或布洛芬。了解药物剂量按体重计算优于年龄或发热高低的护理人会更不容易给予错误的剂量。Physiciansandnursesaretheprimarysourceofinformationonfevermanagementforparentsandcaregivers,althoughtherearesomedisparitiesbetweentheviewsofparentsandphysiciansregardingantipyretictreatment.1Themostcommonindicationsforinitiatingantipyretictherapybypediatriciansareatemperaturehigherthan38.3°C(101°F)andimprovingthechild’soverallcomfort.5Althoughonly13%ofpediatriciansspecificallycitediscomfortastheprimaryindicationforantipyreticuse,6thisintentisgenerallyimpliedintheirrecommendations.Mostpediatricians(80%)believethatasleepingillchildshouldnotbeawakenedsolelytobegivenantipyretics.5尽管对于退热药物的使用，儿科医生和家长之间存在着些许分歧，但是儿科医生和护士仍为家长和护理人发热患儿获取有关发热的治疗信息的主要来源。儿科医生关于退热药物使用的普遍共识为高于38.3℃可使用退热药物同时提升孩子的整体舒适度。尽管有13%的儿科医生特别强调孩子不舒适为使用退热药物的主要指征，但是这一条目通常都会被纳入标准之中。绝大多数（80%）的儿科医生认为不应在患儿的睡眠过程中唤醒患儿以服用退热药物。Antipyretictherapywillremainacommonpracticebyparentsandisgenerallyencouragedandsupportedbypediatricians.Thus,pediatriciansandhealthcareprovidersareresponsiblefortheappropriatecounselingofparentsandothercaregiversaboutfeverandtheuseofantipyretics.7使用退热药物进行退热为家长的常规措施，同时也是儿科医生所推介的处理方式。因此，儿科医生及护士应负责地给予家长和护理人有关发热及退热药物使用的合适建议。PHYSIOLOGYOFFEVER发热的生理学Itshouldbeemphasizedthatfeverisnotanillnessbutis,infact,aphysiologicmechanismthathasbeneficialeffectsinfightinginfection.8–10Feverretardsthegrowthandreproductionofbacteriaandviruses,enhancesneutrophilproductionandT-lymphocyteproliferation,andaidsinthebody’sacute-phasereaction.11–14Thedegreeoffeverdoesnotalwayscorrelatewiththeseverityofillness.Mostfeversareofshortduration,arebenign,andmayactuallyprotectthehost.15Datashowbeneficialeffectsoncertaincomponentsoftheimmunesysteminfever,andlimiteddatahaverevealedthatfeveractuallyhelpsthebodyrecovermorequicklyfromviralinfections,althoughthefevermayresultindiscomfortinchildren.11,16–18Evidenceisinconclusiveastowhethertreatingwithantipyretics,particularlyibuprofenaloneorincombinationwithacetaminophen,in