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口腔溃疡常用药及禁忌!

2016-12-22 佚名 药圈微信号

口腔溃疡:即复发性口疮,是慢性的口腔黏膜小溃疡,深浅不等,为圆形或椭圆形损害,可反复和周期性复发。胃肠功能紊乱、体内缺乏锌铁、微循环障碍、免疫功能低下、维生素缺乏、精神紧张、睡眠不足、肠道寄生虫病、局部创伤等常诱发。临床表现:多发生于口腔非角化区如唇、颊黏膜、舌缘、齿龈等处,为圆形或椭圆形,直径为0.2~0.5cm,溃疡单个或由数个连成一片,溃疡表浅边缘整齐,外观呈灰黄色或灰白色,上覆盖黄白渗出膜

口腔溃疡:即复发性口疮,是慢性的口腔黏膜小溃疡,深浅不等,为圆形或椭圆形损害,可反复和周期性复发。胃肠功能紊乱、体内缺乏锌铁、微循环障碍、免疫功能低下、维生素缺乏、精神紧张、睡眠不足、肠道寄生虫病、局部创伤等常诱发。




临床表现:多发生于口腔非角化区如唇、颊黏膜、舌缘、齿龈等处,为圆形或椭圆形,直径为0.2~0.5cm,溃疡单个或由数个连成一片,溃疡表浅边缘整齐,外观呈灰黄色或灰白色,上覆盖黄白渗出膜,周围黏膜充血、水肿而有红晕,局部有烧灼样疼痛,于进餐时加重,影响进食、说话。严重溃疡直径可达1~3cm,深及黏膜下层甚至肌肉。有自愈性,病程7~10天,严重者此起彼伏,连绵不断。

药物治疗

非处方药


1.甲硝唑含漱液或氯己定含漱液
早晚刷牙后含漱,一次15~20ml,一日2~3次,连续5~10天为1个疗程。

2.溶菌酶含片
有抗菌抗病毒作用和消肿止血作用。含服,每次20mg,一日4~6次。

3.甲硝唑口颊片
粘附于黏膜患处,一次1片,一日3次。饭后用,临睡前加用1片。

4.西地碘含片
可直接卤化细菌的体蛋白,杀菌力强,对细菌繁殖体、芽孢和真菌也有较强的杀菌作用。含服,一次1.5~3mg,—日3~5次。

5.地塞米松粘贴片
具有很强的抗炎作用,降低毛细血管的通透性,减少炎症的渗出,贴片用量较小而作用直接、持久,可促进溃疡愈合。外用贴敷于溃疡处,每处1片,一日总量不得超过3片,连续使用不得过1周。

6.爽口托疮膜
有清湿泻毒,收敛生肌的作用,用时取药膜贴于疮面,一日2~3次。

7.冰硼咽喉散、青黛散等
是中医传统治疗口腔溃疡的主要用药。应用时取少量,吹敷患处,一日2~3次。

10.5%~1%达克罗宁液
用时涂于溃疡面上,连续2次,用于进食前暂时止痛。

8.口服维生素类药物
可维持正常的代谢功能,促进病损愈合,在溃疡发作时给予维生素C,0.1~0.2g,一日3次,复合维生素B,每次1片,一日3次。

处方药


1.10%硝酸银液
溃疡数目少、面积小且间歇期长者可采用烧灼法。放于溃疡面上,至表面发白为度。硝酸银可使溃疡面上蛋白质沉淀而形成薄膜保护溃疡面,促进愈合。

2.复方甘菊利多卡因凝胶
镇痛,于溃疡局部涂布,每日3次,每次约涂0.5厘米凝胶,稍加按摩。

3.2.5%醋酸泼尼松龙混悬液
对持久不愈或疼痛明显的溃疡,可于溃疡部位作黏膜下封闭注射,常用2.5%醋酸泼尼松龙混悬液0.5~lml,加人1%普鲁卡因液1ml在溃疡基底部注射,每周1~2次,共用2~4次。

4.泼尼松
对反复发作的口腔溃疡推荐口服泼尼松,一次10mg,一日3次;或左旋咪唑一次50mg,一日3次,每周服用2次。

注意事项

1.甲硝唑含漱液
用后可有食欲不振、口腔异味、恶心、呕吐、腹泻等反应,偶见有头痛、头晕、失眠、抑郁、皮疹、荨麻疹、白细胞减少,停药后可迅速恢复。长期应用可引起念珠菌感染。

2.西地碘
有轻度刺激感,口含后偶见口干、胃部不适、头晕和耳鸣(发生率约2%),对碘过敏者禁用

3.甲硝唑口颊片
使用期间,不得饮酒或含酒精的饮料

4.氯己定

偶可引起接触性皮炎,高浓度溶液有刺激性,长期使用氯己定含漱液可使牙齿着色,舌苔变黑,味觉失调,儿童和青年口腔偶可发生无痛性浅表脱屑损害。

—般牙膏中均含有阴离子表面活性剂,与氯己定可产生配伍禁忌,使用氯己定含漱液后至少需间隔30min后才可刷牙

5.中药散剂
注意喷药时不要吸气,以防药粉进人呼吸道而引起呛咳

6.地塞米松粘贴片
频繁应用可引起局部组织萎缩,使由皮肤、黏膜等部位侵入的病原菌不能得到控制,引起继发的真菌感染等。另对口腔内有真菌感染者禁用

7.用烧灼法治疗
应注意药液不能蘸得太多,不能烧灼邻近健康组织

8.去除诱发因素
例如含有激素类的吸入剂长期使用后没有及时漱口,造成的口腔溃疡或反复发作,应告知患者养成吸入后即可漱口的习惯,避免残留的药物对口腔黏膜的损伤。保持口腔清洁卫生。

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    2018-10-15 fengxiangxin301

    学习了

    0

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    2016-12-22 小康子70

    为媳妇学习了

    0

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    2016-12-22 186****0580(小山羊)

    学习了,分享了。

    0

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