基于临床用药特点的儿科中成药思考
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摘要
儿科常见的疾病主要有呼吸系统感染、消化系统疾病、免疫系统疾病、皮肤系统疾病等4大类。支气管炎、支气管哮喘、肺炎等呼吸系统疾病是儿科常见病,这3种疾病多以发烧、咳嗽、流鼻涕等现象为主,并多与儿童体质弱有关;儿童消化系统疾病以厌食、呕吐、腹泻、便秘为主;皮肤系统疾病有如头癣、足癣、皮肤癣等癣类疾病,荨麻疹、湿疹等过敏性疾病,痱子、晒伤等皮肤病等。儿童是特殊的用药群体,身体正处于生长发育阶段,各器官发育尚未成熟,具有对疾病的易感性强,应激能力低,对药物反应不敏感等特点,故对药品的用法和用量有其特殊要求。儿童是祖国的未来,然而儿科用药问题重重,儿科用药值得深思。中成药是根据中医药的理法方药和辨证施治的规律及历代治疗经验总结出来的有效方剂经加工而成的丸、散、膏、丹、口服液等中药制剂,多为复方制剂,是经过千百年的医疗实践总结的精华。目前常用的中成药剂型以片剂、丸药、胶囊、口服液、散剂为多。儿科中成药有药性平和、使用方便、含量稳定、量效可控、疗效确切等优点,临床应用广泛。为了确保应用儿科中成药的有效性和安全性,针对儿科患者的特殊性,严格把握儿科中成药的一些注意事项,本文通过分析儿科中成药应用中存在的问题及相应的对策规范保障儿科中成药,提高儿童用药的可及性。
The common diseases in pediatrics department include respiratory diseases,digestive diseases,immune system diseases,and skin system diseases. Bronchitis,bronchial asthma,pneumonia and other respiratory diseases are common pediatric diseases,mainly with the symptoms of fever,cough,and runny nose,and are mostly related to children's physical weakness. Pediatric digestive diseases mainly include anorexia,vomiting,diarrhea and constipation. Skin system diseases mainly include tinea diseases such as tinea capitis,tinea pedis,and tinea corporis,allergic diseases such as urticaria and eczema,scorpions,sunburn and other skin diseases. Children are special groups for drug use,as their body is in the stage of growth and development and their organs are not yet mature,with strong susceptibility to disease,low stress ability,and not sensitive to drug reactions. Therefore,special requirements shall be noticed on the drug use and dosage. Children are the future of the country,but we have so many problems in pediatric drug use. It is worth pondering about pediatric drug use. Chinese patent medicine is a traditional Chinese medicine preparation in the forms of pills,powder,cream,pellet,and oral liquid,which is processed according to the laws and prescriptions of traditional Chinese medicine and the rule of syndrome differentiation and treatment experience,mostly of a compound preparation. This is the essence of medical practice after thousands of years of experience. At present,the commonly used dosage forms for Chinese patent medicine are tablets,pills,capsules,oral liquids and powders. Pediatric Chinese patent medicines have the advantages of mild nature,ease of use,stable content,controllable dose-effect,and exact curative effect,so they are widely used in clinical applications. In order to ensure the effectiveness and safety of pediatric Chinese patent medicine,we should strictly grasp some considerations on pediatric Chinese patent medicine due to the particularity of pediatric patients. This paper would analyze the problems in the application of pediatric Chinese patent medicines and the corresponding countermeasures to improve the accessibility of pediatric medication.
The common diseases in pediatrics department include respiratory diseases,digestive diseases,immune system diseases,and skin system diseases. Bronchitis,bronchial asthma,pneumonia and other respiratory diseases are common pediatric diseases,mainly with the symptoms of fever,cough,and runny nose,and are mostly related to children's physical weakness. Pediatric digestive diseases mainly include anorexia,vomiting,diarrhea and constipation. Skin system diseases mainly include tinea diseases such as tinea capitis,tinea pedis,and tinea corporis,allergic diseases such as urticaria and eczema,scorpions,sunburn and other skin diseases. Children are special groups for drug use,as their body is in the stage of growth and development and their organs are not yet mature,with strong susceptibility to disease,low stress ability,and not sensitive to drug reactions. Therefore,special requirements shall be noticed on the drug use and dosage. Children are the future of the country,but we have so many problems in pediatric drug use. It is worth pondering about pediatric drug use. Chinese patent medicine is a traditional Chinese medicine preparation in the forms of pills,powder,cream,pellet,and oral liquid,which is processed according to the laws and prescriptions of traditional Chinese medicine and the rule of syndrome differentiation and treatment experience,mostly of a compound preparation. This is the essence of medical practice after thousands of years of experience. At present,the commonly used dosage forms for Chinese patent medicine are tablets,pills,capsules,oral liquids and powders. Pediatric Chinese patent medicines have the advantages of mild nature,ease of use,stable content,controllable dose-effect,and exact curative effect,so they are widely used in clinical applications. In order to ensure the effectiveness and safety of pediatric Chinese patent medicine,we should strictly grasp some considerations on pediatric Chinese patent medicine due to the particularity of pediatric patients. This paper would analyze the problems in the application of pediatric Chinese patent medicines and the corresponding countermeasures to improve the accessibility of pediatric medication.
引文
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[34]Kozlovskaya L,Abou-Kaoud M,Stepensky D.Quantitative analysis of drug delivery to the brain via,nasal route[J].J Control Release,2014,189(10):133-140.
[35]吴慧,吴闻哲.经鼻给药增加药物脑靶向的制剂方法[J].世界临床药物,2015,36(1):50-55.
[36]杜丽娜,金义光.经皮给药系统研究进展[J].国际药学研究杂志,2013,40(4):379-385.
[37]陈华,沈洁.小儿退热药的合理选择[J].中国中西医结合儿科学,2012,4(1):11-13.
[38]赵岩松,洪兰,叶桦.美国与欧盟药物研制中的儿童用药研究计划初探[J].中国药事,2017,31(4):358-363.
[39]郭春彦,王彦青,张萌,等.中成药在儿科应用现状的思考与建议[J].中国药学杂志,2017,52(4):327-330.
[40]孙祖越,周莉,韩玲.儿科用药非临床安全性评价要则及中药评价的特殊性[J].中国药理学与毒理学杂志,2016,30(1):13-20.
[41]WANG D,DU X X.Interpretation of adverse drug reaction reporting and monitoring and significance of traditional Chinese medicine adverse drug reaction monitoring[J].China J Chin Mater Med,2012,37(18):2686.
[42]Nordenmalm S,Tomasi P,Pallidis C.More medicines for children:impact of the EU paediatric regulation[J].Arch Dis Child,2018,103(6):557-564.
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[2]Klassen T P,Hartling L,Craig J C,et al.Children are not just small adults:the urgent need for high-quality trial evidence in children[J].PLo S Med,2008,5(8):172.
[3]张靖,秦丹,靳洪涛.儿童用药安全研究评价体系的初步思考[J].中国药物警戒,2017,14(11):657-661.
[4]姜德春,元华龙.儿科超说明书用药的研究现状与进展[J].儿科药学杂志,2013,19(4):53-56.
[5]孙利华,尚阳,唐密.中国儿童用药存在的问题及对策研究[J].国际药学研究杂志,2016,43(4):597-601.
[6]杨娜,胡思源.儿童疾病负担及药物研发需求浅析[J].药物评价研究,2016,39(3):329-334.
[7]张凤霞,周敦新.儿童用药安全性和有效性的影响因素分析[J].中国医药指南,2014,12(3):55-56.
[8]刘晶.儿科中成药的合理用药分析[J].光明中医,2017,32(15):2145-2146.
[9]史学.儿科常用中成药的合理应用[J].儿科药学杂志,2016,22(3):19-20.
[10]钱丹,李智君,成琳.儿科医院中成药的应用状况[J].中国现代药物应用,2014,8(13):236-237.
[11]梁萍,宋民宪,王东晓.治疗小儿惊风的含朱砂中成药的分析[J].华西药学杂志,2011,26(2):196-198.
[12]刘伟招,陈耀金.从小儿体质特征探讨儿科临床用药特点[J].福建中医药,2014,45(4):47.
[13]徐彬彬,姜之炎.小儿肺炎的中医药研究进展[J].光明中医,2013,28(2):433-435.
[14]房志鑫,王建彬.中成药辨证治疗小儿腹泻[J].河南中医,2013,33(12):2225-2226.
[15]国家药典委员会.中华人民共和国药典.一部[M].北京:中国医药科技出版社,2015:425-1749.
[16]Carnovale C,Conti V,Perrone V,et al.Paediatric drug use with focus on off-label prescriptions in lombardy and implications for therapeutic approaches[J].Eur JPediatr,2013,172(12):1679-1685.
[17]黄芳华,朱飞鹏,笪红远,等.中药儿科用药非临床安全性评价的一般考虑[J].中国新药杂志,2015,24(24):2779-2781.
[18]田虹,田侃.浅议完善含毒性药材的儿童用中成药的管理规范[J].中国药房,2014,25(23):2203-2205.
[19]周燕红.小儿至宝丸中朱砂和雄黄的含量测定[J].中国药师,2015,18(12):2193-2195.
[20]詹洪春,刘志学.温建民:两亿多儿童用药奇缺难题亟待破解[J].中国当代医药,2016,23(8):6-7.
[21]陈勇.儿科应用中成药存在的不良反应分析[J].当代临床医刊,2017,30(5):3449.
[22]董颖.对我国儿童用药安全问题的思考[J].中国药物警戒,2009,6(7):401-403.
[23]李学娟,陈泽彬,邱宝明,等.338例儿童药品不良反应报表回顾性分析[J].中国医院药学杂志,2016,36(8):662-666.
[24]Ren Z,Zajicek A.Review of the Best Pharmaceuticals for Children Act and the Pediatric Research Equity Act:What can the obstetric community learn from the pediatric experience?[J].Semin Perinatol,2015,39(7):530-531.
[25]袁娴芬.儿童用药安全的思考[J].临床医药文献电子杂志,2017,4(44):8596-8597.
[26]Rietnales D A V,Jager K E D,Schobben A F,et al.The availability and age-appropriateness of medicines authorized for children in the Netherlands[J].Brit J of Clin Pharmacol,2011,72(3):465-473.
[27]李豹,张映芬.儿科中成药临床应用现状分析[J].中医儿科杂志,2015,11(5):55-56.
[28]王春荣.浅析中成药在儿科临床应用中存在的问题与对策[J].甘肃中医,2010,23(2):21-23.
[29]胡思源,钟成梁,杨娜,等.儿科中成药的临床有效性探索[J].药物评价研究,2015,38(1):71-73.
[30]Thabet Y,Walsh J,Breitkreutz J.Flexible and precise dosing of enalapril maleate for all paediatric age groups utilizing orodispersible minitablets[J].Int J Pharm,2018,541(1-2).
[31]朱金凤,陈建荣.中药直肠给药研究进展[J].中华中医药杂志,2013,28(3):768-771.
[32]朱明红.中药直肠给药在儿科疾病治疗中的应用[J].世界最新医学信息文摘,2017,17(7):109-110.
[33]雷婷婷,赵荣生.雾化吸入给药的临床应用现状及研究进展[J].临床药物治疗杂志,2016,14(3):1-5.
[34]Kozlovskaya L,Abou-Kaoud M,Stepensky D.Quantitative analysis of drug delivery to the brain via,nasal route[J].J Control Release,2014,189(10):133-140.
[35]吴慧,吴闻哲.经鼻给药增加药物脑靶向的制剂方法[J].世界临床药物,2015,36(1):50-55.
[36]杜丽娜,金义光.经皮给药系统研究进展[J].国际药学研究杂志,2013,40(4):379-385.
[37]陈华,沈洁.小儿退热药的合理选择[J].中国中西医结合儿科学,2012,4(1):11-13.
[38]赵岩松,洪兰,叶桦.美国与欧盟药物研制中的儿童用药研究计划初探[J].中国药事,2017,31(4):358-363.
[39]郭春彦,王彦青,张萌,等.中成药在儿科应用现状的思考与建议[J].中国药学杂志,2017,52(4):327-330.
[40]孙祖越,周莉,韩玲.儿科用药非临床安全性评价要则及中药评价的特殊性[J].中国药理学与毒理学杂志,2016,30(1):13-20.
[41]WANG D,DU X X.Interpretation of adverse drug reaction reporting and monitoring and significance of traditional Chinese medicine adverse drug reaction monitoring[J].China J Chin Mater Med,2012,37(18):2686.
[42]Nordenmalm S,Tomasi P,Pallidis C.More medicines for children:impact of the EU paediatric regulation[J].Arch Dis Child,2018,103(6):557-564.
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