孩子反复发烧的护理方法.doc

4孩子反复发烧的护理方法“医生，快点，我孩子又烧到39了！”心情焦虑的父母抱着孩子冲进诊室。这是在儿科极为常见的一幕。“早上来看过医生了，打了针吃了药，下午又开始烧起来了。怎么就不退烧呢？”这又是父母们最常问的问题。当小孩发烧后，家长往往手足无措，着急、焦虑，恨不得立即能给孩子退烧。专家指出，其实，治疗感染需要一个过程，退烧也只是对症处理，而且38.5以上才需要用退烧药。大多数时候，还需要家长使用物理降温的办法。感染是引起孩子发烧的主因发热的症状相似，但引起发热的原因却有不同。在临床上，根据致热源(引起发热的物质)来源不同，发热可分为感染性和非感染性。在儿科，绝大部分 的发热都是感染性的。人体的各个部位都可能发生感染，比如小孩常见的喉咙发炎、气管炎、肺炎、肠炎等，只有把感染消除了，发热才能停止。“能感染人体的东西有很多，最常见的是病毒、细菌，其次是支原体、衣原体。”广州市第一人民医院儿科主任于力说，目前，支原体感染很常见。支原 体感染的早期症状跟普通感冒差不多，如低烧、咳嗽等，因而不少家长常常会把孩子支原体感染错以为是感冒，给孩子服用感冒药，结果治了一个多月还不见好。于力说，治疗支原体感染疗程较长，4个疗程差不多需要一个月时间，让体内药物达到一定的浓度，才能彻底治愈感染。低于38.5，不必用退烧药要清除这些病毒、细菌、支原体等致病体，除了人体自身的免疫力外，对于小孩，常常还需要借助药物。不过，于主任说，即使用了恰好针对感染病原且 昂贵的进口药物，病原体的清除也不会马上起效，治疗需要一段时间。所以，家长无需那么心急，家长要做的就是认真做好物理降温及补水等护理。但如果孩子一直处于高热状态，比如体温超过39，就应该引起足够的重视，因为高热持续时间长，会对心、肺、脑、胃肠等功能有不良影响，尤其是 1岁-3岁半的孩子，最容易出现高热惊厥，对大脑神经组织有一定的损伤。因此，在使用抗感染药物的同时，还要给孩子进行退热等对症处理。一般来说，婴幼儿测量肛温超过37.8或腋温超过37.5时，就可以认为发烧了。于力指出，建议对于不同的发热状况予以不同的对策(1)超过37.5(可以选择物理降温)(2)超过38.5(可以口服药物来退热)(3)超过39(可以注射用药来退热)Tips：药物降温要点原则是“能口服不用注射”，口服药物一般要两小时后才能起效，对于高热的孩子，一天可以口服四次退烧药。(1)一般不建议使用多种药物同时降温。降温药物一般是叫“非甾体类消炎药”的药物，剂型多样，但由于原理类似，同时使用时容易使体温下降过猛，由于出汗太多，甚至引起虚脱。(2)可以重复使用一种退烧药。由于并没有去除致热源这个根本原因，尽管在使用药物后体温下降，但当药效过了以后，致热源继续影响人体导致发 热，所以，“早上看了病，打完了针，下午又烧起来了”的情形就不奇怪了。因此，当孩子体温再次超过38.5，可以再服用退烧药。不过，要真正退热，还是 要消除感染。(3)非甾体消炎药有一些副作用，这类药应该在医生的指导下使用。(4)三个月以下的小婴儿，发烧的时候一般不主张用任何退烧药，而应采取物理降温。物理降温要点与成年人不同的是，孩子不能依赖多穿衣物捂汗降温，这是因为小孩子的体温调节发育还不完善，捂汗容易引起脱水而休克。(1) 药物降温配合物理降温能达到更好的退热效果。一般的做法是用退热贴或冰袋敷在额头，用温水、33%的酒精不断拭抹颈侧、腋窝、大腿根部的皮肤，或洗温水澡。(2)在孩子觉得冷或手脚冰凉的时候，不适宜做物理降温，这时反而要注意保暖，用衣被盖好手脚或喝点热水，等手脚变热了，就要撤掉衣被开始物理降温。(3)物理降温选用的部位要避开心前区、手心、脚心等，以避免局部刺激诱发条件发射导致不良后果。也不宜全身范围地拭抹酒精或敷冰，选用颈侧、腋窝、大腿根部是因为这些地方有大动脉经过，散热的效应较好。Doctor, hurry up, my children to 39 again! Anxious parents holding the children rushed into the office. This is very common in pediatric patients. To see a doctor in the morning, the injection took the pills, began to burn up in the afternoon. How dont go away? It is the parents the most often asked question.After the children have a fever, parents often unprepared, worry, anxiety, wish can immediately give children fever. Experts point out that, in fact, the treatment of infection requires a process, only symptomatic treatment, fever and 38.5 above only need use antipyretics. Most of the time, you also need to use physical cooling method.Infection is the cause of the feverThe symptoms of fever, but the cause that causes fever are different. In clinic, according to the different heat source (substances cause fever) source, fever can be divided into infectious and non-infectious. In pediatrics, the vast majority of fever are infectious. Infection in different parts of the body can be changed, such as child common sore throat, bronchitis, pneumonia, enteritis, etc., only to eliminate the infection, fever can stop.There are a lot of things can infect the human body, is the most common viruses, bacteria, followed by mycoplasma, chlamydia. Guangzhou is the first peoples hospital of pediatrics director said that at present, the mycoplasma infection is very common. Mycoplasma infection to the early symptoms of the common cold, such as fever, cough, so many parents leave their children often mycoplasma infection wrong thought it was a cold, take medicine to the child, the cure for more than a month is not good.Force, treatment of mycoplasma infection course is longer, need a month, almost four treatment to reach a certain concentration of drug in your body, can completely cure the infection.Less than 38.5 , need not use antipyreticsTo remove these viruses, bacteria, mycoplasma and other circulating, in addition to the bodys own immune system, for children, often need to use drugs. However, the director said that using just for infection pathogens and expensive imported drugs, pathogen removal will not take effect immediately, treatment over a period of time. So, parents need not so impatient, parents have to do is to make physical cooling, hydrating care, etc.But if a child has been in hot state, such as temperature more than 39 , should cause enough attention, because of long time high fever, will treat, lungs, brain, gastrointestinal function is bad, especially at the age of 1-3 and a half years old children, the most prone to febrile convulsion, nerve tissue has certain damage to the brain. Therefore, in the use of anti-infective drugs at the same time, to give the child to symptomatic treatment such as fever.In general, infants and young children measurement anal temperature more than 37.8 or axillary temperature is more than 37.5 , it can be thought of as a fever. Is pointed out that, it is suggested that for different heating conditions of different countermeasures -(1) more than 37.5 (can choose physical cooling)(2) more than 38.5 (can oral drug to antifebrile)(3) more than 39 (can be antifebrile injection drug use)Tips:Drug cooling pointsPrinciple is to oral without injection, oral drugs generally need two hours to work, for high fever, fever can oral four times a day.(1) generally do not recommend the use of a variety of drugs at the same time. Cooling drugs are generally called nonsteroidal anti-inflammatory drugs drugs, dosage form is diversiform, but due to the similar principle, makes the body temperature drop too hard when used at the same time, because of the sweat too much, even lead to collapse.(2) can be repeated use of a fever. Because did not remove pyrogens the root causes, although hypothermia after using drugs, but when the efficacy of a pyrogen continue to affect the human body causes hair hot, so, see a doctor in the morning, played the needle, and burn up in the afternoon situation is understandable. Once again, therefore, when a childs temperature more than 38.5 , can again taking fever-reducing medication. However, to truly antifebrile, or to eliminate the infection.(3) the non-steroidal anti-inflammatory drugs have some side effects, such as drug use should be under the guidance of a doctor.(4) the following three months baby, fever generally does not advocate using any fever, and physical cooling should be taken.Physical cooling pointsUnlike adults, children cant depend on how to wear cool clothes wu khan, this is because the temperature regulation and development of children is not perfect, wu sweat easily lead to dehydration and shock.(1) drug cooling with physical cooling can achieve better antifebrile effect. Common practice is to use cooling gel or ice packs in the forehead, with