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120-7-第七节 抗疟药的用药原则
前已提到,视网膜的毒性反应限制抗疟药的剂量。提高剂量,虽可提高疗效,然而毒性反应也相应提高。当前国内外常用的剂量为:经氯喳400mg/d,氯喳250mg/d。如按体重计算,每日剂量分别为6.5mg/kg和4mg/kg。把剂量控制在这种水平以下,一般是比较安全的。但是因为服药时间很长,累积剂量很高,也有视网膜病变的可能性。定期做视野和眼底等检查,能及早发现早期的轻微病变,及时停药。因此,眼科检查已成为常规(表120一2).
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+ z. l3 R, x1 f; ^" w# y) y! | 按照表120一2中规定,病人在服药前应先做视野检查,确定病人服药前的视野基线,然后每6个月做一次眼科检查。如检查中发现任何一种异常变化,立即停药,可避免受监察病人发生严重的视网膜病。由于病人接受抗疟药初期副作用较多,疗效又不能很快显示,如病人对副作用能耐受的话,应劝病人坚持服药满6个月,再决定是否停药还是继续治疗。显效后继续用到病情缓解,然后适当减量,控制病情在稳定期。
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0 N8 I& p8 D! h9 I7 y9 N 综上所述,抗疟药治疗各种风湿病都有一定疗效,副作用较其他抗风湿病药为轻。采取控制剂量和定期眼科检查等措施后,眼视网膜病变的发生率很低,因此,国内外仍被广泛应用。 9 ?: u% L& w7 L1 N# {
( 叶益新 张江林 黄 烽 )
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