急性胃腸炎的用藥指導

1、急性胃腸炎的用藥指導（雙語）【疾病概述】急性胃腸炎多由于飲食不當，吃了過多生冷不易消化和刺激性食物，或進食了被細菌污染的食物而發(fā)病。主要病理變化為胃腸粘膜呈急性炎癥、水腫、充血及分泌物增加。臨床表現(xiàn)以惡心、嘔吐、腹痛、腹瀉、發(fā)熱為主，嚴重者可出現(xiàn)脫水及電解質(zhì)紊亂、酸中毒、休克。病人多表現(xiàn)為惡心、嘔吐在先；繼以腹瀉，每日35次甚至數(shù)十日不等，大便多呈水樣，深黃色或帶綠色，惡臭，可伴有腹部絞痛、發(fā)熱、全身酸痛等癥狀。在我國以夏、秋兩季發(fā)病率較高，無性別差異，一般潛伏期為123 6小時。分類可分為急性胃炎、急性腸炎、急性胃腸炎三型：1. 急性胃炎表現(xiàn)為惡心、嘔吐、上腹部疼痛不適等。以惡心嘔吐為主，病

2、變部位則在胃。2. 急性腸炎表現(xiàn)為腹痛腹瀉一日數(shù)次或數(shù)十次，糞便為糊狀 或為黃色水樣可帶有泡沫或少量粘液有的呈洗 肉水樣。以腹瀉為主的，病變部分在腸。3. 急性胃腸炎發(fā)病快，來勢猛，如不及時治療，可因失水 過多出現(xiàn)酸中毒，甚至發(fā)生休克，因此得病應(yīng)及 時請醫(yī)生治療。治療治療原則：解除誘因，對癥治療，適當止痛止瀉，確定致病 菌后給予抗菌治療。(1) 一般治療：盡量臥床休息，口服葡萄糖一電解質(zhì)液以 補充體液的丟失。如果持續(xù)嘔吐或明顯脫水，則需靜脈補充5% 10%葡萄糖鹽水及其他相關(guān)電解質(zhì)。鼓勵 攝人清淡流質(zhì)或半流質(zhì)食品，以防止脫水或治療輕 微的脫水。(2) 對癥治療：必要時可注射止吐藥：例如肌肉注射

3、氯丙 嗪25-100mgl日。解痙藥：如顛茄浸膏， 10-30mg, 1 日3次。止瀉藥：如思密達每次 1袋，1日2-3次。(3) 抗菌治療：對于感染性腹瀉，可適當選用有針對性的抗菌素，如黃連素0.3g 口服，1日3次或慶大霉 素8萬u 口服，1日3次等。但應(yīng)防止抗菌素濫用?！灸M情景對話】藥師：您好！請問我能幫助您什么？Pharmacist : Hello, can I help you?患者：我肚子痛，還拉肚子，想來買點藥。Patient : I have stomachache and diarrhea. I want to buy some medicine.藥師：有多長時間了？Pha

4、rmacist : How long does it last?患者：昨天晚上開始。Patient : From last night.藥師：您昨天吃了什么東西？Pharmacist : What did you eat yesterday?患者：昨晚在外面吃了頓麻辣湯，結(jié)果半夜三更就開始肚子 痛了。Patient : I ate hot spicy soup outside last night, and then I began stomachache later at night.藥師：有沒有其它人一起同您去吃，他們有沒有出現(xiàn)像您這 樣的情況？Pharmacist : Was there

5、 any other person with you? Wasthere something wrong with them?患者：我和我同事一起去吃，但他們沒事。Patient : Yes, mycolleagues with me, but they are well.藥師：肚子具體哪個部位痛？上腹部還下腹部？(可作適當 的按診)Pharmacist : Which specific part of the stomach ispainful ? The upper abdomen or the lower abdomen( Give theappropriate examine with

6、 fingers)患者：肚臍周圍疼痛。Patient : Pains around the navel.藥師：什么性質(zhì)的腹痛？痛的時候能不能忍受？Pharmacist : What kind of abdominal pain? Can you bear the pain?患者：剛開始一陣一陣地隱痛，后來就痛得越來越利害了， 痛得我直冒冷汗，而且痛的時候就要上廁所。Patient : There was a dull pain in a while at the beginning, and then more and more painful so that I broke into aco

7、ld sweat. When it pained, I need go to the toilet.藥師：便后有什么感覺？肛門有沒有灼熱感？便后疼痛能不 能緩解？Pharmacist : How about the feelings after using the restroom? Did your anus feel hot? Would you ease the pain after defecation?患者：便后感覺肚子舒服了一些，肛門沒有灼熱感。Patient : My stomach felt well after it, and no hot sensation at anus

8、.藥師：您要多長時間上一次廁所?Pharmacist : How often did you go to the toilet?患者：時間不定，肚子痛時，有時候就想上。Patient : There is no definite time. When the stomachpained, I would go to it.藥師：您從昨晚到現(xiàn)在上了幾次廁所？Pharmacist : How many times did you go to the toiletfrom last night?患者：大概7-8次吧，Patient : About 7-8 times.藥師：每次大便量多不多？主要成什

9、么顏色？Pharmacist : Was the volume of each bowel movementmuch more? What color mainly?患者：剛開始呈黃色糊狀便，后為稀水樣便Patient : At first yellow paste stool, then watery one.藥師：便中有沒有夾雜食物殘渣？Pharmacist : Was there some mixture of food residue?患者：有一些Patient : Yes, there are some.藥師：有沒有嘔吐現(xiàn)象？Pharmacist : Did you have vomiting?患者：有，痛得利害時就想嘔吐，但是吐不出來。Patient : Yes, I wanted to vomit when more and more pains, but I couldn ' t spit out.藥師：有沒有發(fā)熱或怕寒的現(xiàn)象？Pharmacist : Did you have a fever or have the fear of cold?患者：沒有。P