阿司匹林

阿司匹林应用五禁忌

说到阿司匹林,大家都很熟悉,由于小剂量的阿司匹林有预防心脑血管病的作用,所以服用者众多。但是,阿司匹林有致皮肤、内脏出血及胃肠道刺激等副作用,有时还会引起严重的后果。因此,患者在服用阿司匹林时应注意以下禁忌。

一忌剂量过小、过大

国内一项针对阿司匹林的调查显示,阿司匹林应用十分普遍,大家对其认同程度也较高。但是,由于患者害怕阿司匹林的副作用,用量大都过低,用法亦不规范。那么,多大的剂量才算是合适的呢?研究发现,服用50毫克阿司匹林后,血小板的聚集作用开始受到抑制,当剂量达到75毫克后,血小板的聚集被完全抑制。因此,一般推荐心脑血管病患者的治疗剂量为75~325毫克,国内常用剂量为100毫克,一次顿服。剂量太小或分开几次服用,均无法达到治疗目的。对于仅有危险因子但没有心脑血管疾病的老年人而言,预防性用药的剂量同样不宜过小,小于50毫克的阿司匹林是根本没有作用的。同样,如果阿司匹林用量过大,不但容易导致皮肤及内脏出血,而且可以引起肝脏、肾脏的损害。

二忌随意服药

从人体的生物钟来看,早上6点到10点,血粘度较高,血压、心率水平也高,所以这段时间是心脑血管意外的高发时间。阿司匹林在体内起效时间较快,因此,为达到治疗和预防心脑血管疾病的目的,早上8点左右服用较为合适。为减少药物对胃的刺激,最好在饭后半小时左右服用,切不可空腹服药。

三忌突然停药

由于很多老年人都是心脑血管病的高危人群,本身就很容易发生血栓,停用阿司匹林后的确存在发生心脑血管意外的可能。所以在没有特殊情况存在时,不要随便停用阿司匹林,尤其在手术后,阿司匹林作为治疗药物更不能突然停用。如果是因为过敏、活动性溃疡不能应用阿司匹林,可以在医生指导下改服其他药物,如双嘧达莫、噻氯匹定、波立维等,这些药物也有良好的抗血小板聚集作用,只要遵医嘱服用,同样可以起到良好的效果。

四忌胃病用药

阿司匹林又名乙酰水杨酸,是一种酸性药物,对胃有一定的刺激作用,同时还会通过直接和间接的途径刺激胃粘膜,加上阿司匹林对止血过程的抑制,如果原来就有活动性溃疡,服用阿司匹林无异于雪上加霜,使溃疡难以愈合,甚至引起大出血。现在市场上的阿司匹林大多为肠溶片,一般不会在胃里溶解,对胃的刺激已大大减少,但有活动性溃疡的患者还是不能服用。

五忌有可能出现危险时用药

由于阿司匹林会抑制血小板的聚集,使出血难止,外科手术又必定会有创面,因此手术前尤其是创伤比较大的手术前,最好停用阿司匹林。科学研究发现,当阿司匹林完全抑制血小板聚集后,这种抑制作用会在血小板的整个循环过程中持续存在,直到新的血小板产生,一般来说,一个血小板的循环周期大约是1 周,但由于人体的骨髓中不断有新的血小板释放出来,因此,最好在术前3天停用阿司匹林。此外,血液病患者或月经期女性,由于机体有出血的危险,也应该减少或停止应用阿司匹林。

总之,每个人的情况千差万别,服用阿司匹林的剂量和方法也不完全相同,建议患者在医生指导下服用,使阿司匹林发挥应有的效应。

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