Drwal-Klein L A, Phelps S J
Department of Pharmacy Practice, Massachusetts College of Pharmacy and Allied Health Sciences, Boston 02115.
Clin Pharm. 1992 Dec;11(12):1005-21.
General principles of thermoregulation, the pathophysiology of fever, controversies concerning the use of antipyretic therapy, and nonpharmacologic and pharmacologic treatments commonly used for antipyresis in the pediatric population are reviewed. Several arguments can be made for not ameliorating the febrile response. Fever is an important diagnostic and prognostic clinical sign that may have beneficial effects for the host. In addition, body temperatures of < or = 41 degrees C (105.8 degrees F) are relatively harmless. Reasons for treating fever include patient discomfort, the potential for adverse sequelae, the possibility of seizures, and the possibility that fever could affect the pharmacokinetic profiles of drugs. Nonpharmacologic treatment for fever includes environmental measures to enhance dissipation of body heat and sponging. Aspirin and acetaminophen are the agents used most frequently for antipyresis in pediatric patients. However, aspirin use in children with a viral illness has been associated with development of Reye's syndrome. As a result, its use in children has declined in the United States. Acetaminophen is relatively free of adverse effects and is considered first-line pharmacologic antipyresis therapy. Ibuprofen suspension should be considered as second-line antipyretic therapy. Combination therapy with acetaminophen and aspirin may be considered if the patient fails to respond to other nonpharmacologic and pharmacologic therapies; however, combination therapy may result in increased risk of drug toxicity, increased probability of adverse reactions, and increased risk of intoxication. Aspirin, acetaminophen, and ibuprofen are equally effective for antipyresis in pediatric patients. However, because acetaminophen is the safest medication, it is currently the therapy of choice.
本文综述了体温调节的一般原则、发热的病理生理学、关于使用退热疗法的争议，以及儿科人群中常用的非药物和药物退热治疗方法。对于不改善发热反应有几个理由。发热是一个重要的诊断和预后临床体征，可能对宿主有有益作用。此外，体温≤41℃（105.8℉）相对无害。治疗发热的原因包括患者不适、出现不良后遗症的可能性、惊厥的可能性，以及发热可能影响药物药代动力学特征的可能性。发热的非药物治疗包括增强体热散发的环境措施和擦浴。阿司匹林和对乙酰氨基酚是儿科患者最常用的退热剂。然而，在患有病毒感染的儿童中使用阿司匹林与瑞氏综合征的发生有关。因此，在美国其在儿童中的使用已经减少。对乙酰氨基酚相对无不良反应，被认为是一线药物退热疗法。布洛芬混悬液应被视为二线退热疗法。如果患者对其他非药物和药物疗法无反应，可考虑对乙酰氨基酚和阿司匹林联合治疗；然而，联合治疗可能会增加药物毒性风险、不良反应发生概率和中毒风险。阿司匹林、对乙酰氨基酚和布洛芬在儿科患者中退热效果相同。然而，由于对乙酰氨基酚是最安全的药物，它目前是首选治疗方法。
