Mackowiak Philip A, Plaisacne Karen I
VA Maryland Health Care System, Baltimore, Maryland 21201, USA.
Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
Ann N Y Acad Sci. 1998 Sep 29;856:214-223. doi: 10.1111/j.1749-6632.1998.tb08328.x.
Physicians have used various forms of antipyretic therapy since antiquity to lower the temperature of febrile patients. Nevertheless, it has yet to be determined whether the benefits of antipyretic therapy outweigh its risks. It is not known, for example, if core temperatures encountered during the febrile state ever reach levels that are intrinsically noxious (and therefore merit antipyretic intervention) or when, if ever, fever's metabolic costs exceed its physiologic benefits, or if the benefits of symptomatic relief afforded by antipyretic drugs consistently exceed their toxicologic cost. Whereas preliminary experimental and clinical observations suggest that antipyretic therapy has the potential to increase the duration and/or severity of certain infections, such data are as yet too fragmentary to draw firm conclusions regarding their validity. Finally, although clinicians have long suspected that bacteremia and other severe infections might induce fevers that are less responsive to antipyretic therapy than are those associated with self-limited infections, this concept has not held up under scientific scrutiny. Thus, despite over 2.5 millennia of clinical experience, important questions regarding the risks and benefits of antipyretic therapy remain to be answered.
自古以来，医生们就采用各种形式的退热疗法来降低发热患者的体温。然而，退热疗法的益处是否超过其风险仍有待确定。例如，尚不清楚发热状态下的核心体温是否曾达到本质上有害的水平（因此值得进行退热干预），或者发热的代谢成本何时（如果有的话）会超过其生理益处，又或者退热药所带来的症状缓解益处是否始终超过其毒理学成本。尽管初步的实验和临床观察表明，退热疗法有可能增加某些感染的持续时间和/或严重程度，但此类数据仍过于零散，无法就其有效性得出确凿结论。最后，尽管临床医生长期以来一直怀疑菌血症和其他严重感染可能引发对退热疗法反应不如自限性感染所致发热敏感的发热，但这一概念在科学审视下并未成立。因此，尽管有超过两千五百年的临床经验，但关于退热疗法风险和益处的重要问题仍有待解答。
