用药:镇痛药那么多,该怎么选择呢?

2015-11-06 佚名 医学之声

镇痛药是用于消除或缓解人体组织疼痛的药物。然而,并非任何一种镇痛药都能解除人体所有部位的疼痛,也就是说,人体各部位的疼痛对于镇痛药是有选择性的。根据其镇痛作用和部位,镇痛药分为中枢抑制性镇痛药、解热镇痛药、抗炎镇痛药、平滑肌解痉药。 中枢抑制性镇痛药 如阿片生物碱类(吗啡、可待因)与人工合成品(哌替啶、阿法罗定、芬太尼、美沙酮、喷他佐辛、二氢埃托啡等),对大脑痛觉中枢具有抑制作

镇痛药是用于消除或缓解人体组织疼痛的药物。然而,并非任何一种镇痛药都能解除人体所有部位的疼痛,也就是说,人体各部位的疼痛对于镇痛药是有选择性的。根据其镇痛作用和部位,镇痛药分为中枢抑制性镇痛药、解热镇痛药、抗炎镇痛药、平滑肌解痉药。


中枢抑制性镇痛药

如阿片生物碱类(吗啡、可待因)与人工合成品(哌替啶、阿法罗定、芬太尼、美沙酮、喷他佐辛、二氢埃托啡等),对大脑痛觉中枢具有抑制作用,起到强大的镇痛效果,常用于外伤性剧痛(如严重创伤、烧伤、骨折等)、内脏绞痛(如心绞痛、肾绞痛、胆绞痛时与阿托品合用)、癌症剧痛、手术后疼痛等。尽量避免长时间使用,以免药物成瘾。此外,在明确诊断前也应尽可能不用,以免掩盖病情,贻误诊治。

解热镇痛药

如阿司匹林、扑热息痛、去痛片(又名索米痛)、复方氨基比林(又名优散痛)、扑炎痛、安乃近、赖氨匹林等,可以抑制或减少前列腺素合成,起到镇痛作用。这类药物具有中等程度的镇痛作用,一般对钝痛效果较好,对外伤性剧痛、内脏平滑肌绞痛则无效,常用于头痛、牙痛、肌肉痛、关节痛、月经痛等。但副作用较大,常见胃痛、呕吐、恶心、胃出血、哮喘、延长凝血酶原时间、抑制血小板凝集等,故患有胃、肝、肾、血液等疾病,以及孕妇、过敏体质者不宜服用。

非激素类抗炎镇痛药

如消炎痛(又名吲哚美辛)、消炎灵、炎痛昔康、抗炎酸钠(又名甲氯芬那酸、甲氯灭酸)、双氯灭痛(又名双氯芬酸、扶他林)、消痛灵(又名奈普生)、布洛芬(又名拔怒风、芬必得)、抗炎灵、氟灭酸、保泰松等,特点是消炎作用较强,镇痛效果显著,常用于风湿性关节炎、类风湿性关节炎、骨关节炎等非特异性炎症所引起的疼痛。其不良反应及禁忌症与解热镇痛药大致相同,患有胃、肝、肾、血液等疾病的人,以及孕妇应避免使用。

平滑肌解痉药 

如阿托品、消旋山莨菪碱(654-2)、东莨菪碱、颠茄酊、普鲁苯辛、溴苯辛等,能解除平滑肌痉挛,缓解平滑肌痉挛引起的各种内脏绞痛,常用于胃肠痉挛性疼痛、肾绞痛、胆绞痛等。这类药物使用剂量过大时可出现口干、心悸、视力模糊、眩晕、排尿困难等副作用,因此,凡是有青光眼、前列腺肥大、幽门梗阻等疾病的患者应禁用,老年人及心功能不全的患者也应慎用。

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    2017-07-12 calamus

    能列表就好了

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=221275, encodeId=f2552212e5e3, content=能列表就好了, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/07/12/ff0a4e3372edb1a96b22ecef08bdb975.jpg, createdBy=309e66350, createdName=calamus, createdTime=Wed Jul 12 07:11:08 CST 2017, time=2017-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=139269, encodeId=bcc4139269d2, content=涨见识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=84e21956153, createdName=1e1263e3m20(暂无匿称), createdTime=Mon Oct 03 00:16:55 CST 2016, time=2016-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355215, encodeId=bb0713552157f, content=<a href='/topic/show?id=256a96e9990' target=_blank style='color:#2F92EE;'>#镇痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96799, encryptionId=256a96e9990, topicName=镇痛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Nov 08 00:36:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1579717, encodeId=7c6c15e971721, content=<a href='/topic/show?id=567c96806cc' target=_blank style='color:#2F92EE;'>#镇痛药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96806, encryptionId=567c96806cc, topicName=镇痛药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ef4d16558274, createdName=ms9476844295372110, createdTime=Sun Nov 08 00:36:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42683, encodeId=4d4f4268355, content=真是长了不少见识!在临床上用药还是比较乱的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151101/IMG5635562CC617F7689.jpg, createdBy=bf351605554, createdName=xjbtdbs150wgf, createdTime=Fri Nov 06 20:43:00 CST 2015, time=2015-11-06, status=1, ipAttribution=)]
    2016-10-03 1e1263e3m20(暂无匿称)

    涨见识了

    0

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    2015-11-08 zhaojie88
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  5. [GetPortalCommentsPageByObjectIdResponse(id=221275, encodeId=f2552212e5e3, content=能列表就好了, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/07/12/ff0a4e3372edb1a96b22ecef08bdb975.jpg, createdBy=309e66350, createdName=calamus, createdTime=Wed Jul 12 07:11:08 CST 2017, time=2017-07-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=139269, encodeId=bcc4139269d2, content=涨见识了, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=84e21956153, createdName=1e1263e3m20(暂无匿称), createdTime=Mon Oct 03 00:16:55 CST 2016, time=2016-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355215, encodeId=bb0713552157f, content=<a href='/topic/show?id=256a96e9990' target=_blank style='color:#2F92EE;'>#镇痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96799, encryptionId=256a96e9990, topicName=镇痛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Sun Nov 08 00:36:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1579717, encodeId=7c6c15e971721, content=<a href='/topic/show?id=567c96806cc' target=_blank style='color:#2F92EE;'>#镇痛药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96806, encryptionId=567c96806cc, topicName=镇痛药)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ef4d16558274, createdName=ms9476844295372110, createdTime=Sun Nov 08 00:36:00 CST 2015, time=2015-11-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=42683, encodeId=4d4f4268355, content=真是长了不少见识!在临床上用药还是比较乱的。, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151101/IMG5635562CC617F7689.jpg, createdBy=bf351605554, createdName=xjbtdbs150wgf, createdTime=Fri Nov 06 20:43:00 CST 2015, time=2015-11-06, status=1, ipAttribution=)]
    2015-11-06 xjbtdbs150wgf

    真是长了不少见识!在临床上用药还是比较乱的。

    0