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病例一： 李女士三岁的女儿月月拉肚子。李女士看到一篇科普文章说，小儿常服诺氟沙星会影响骨骼发育，她就想请医生给开点庆大霉素口服。儿科主任告诉她，庆大霉素口服对小儿不是非常适合。李女士这下不明白了。 专家指导：一般人认为，庆大霉素对小儿听力的损害是因为庆大霉素吸收进入血液后所造成，因此从《药典》到药品说明书都认为，庆大霉素对小儿不宜注射但可以口服。但最新研究表明，在某些特殊情况下，口服同样有造成患儿耳聋的危险。口服庆大霉素的耳、肾毒性少有人注意，是因为传统理论认为口服庆大霉素很少吸收入血引起全身作用，只在胃肠道起局部作用，所以不用担心其耳、肾毒性。正是如此，目前市场上有庆大霉素口服剂型供应，甚至有专供小儿使用的口服剂型。 最新研究表明，口服庆大霉素在肠道健康的情况下的确很少吸收，但当肠道发生炎症特别是广泛炎性病变、溃疡性病变和痢疾急性期时，口服后吸收入血的量就会增加，当增加到一定程度时就可能产生耳毒性导致听力下降甚至耳聋。虽然这一类抗生素（氨基糖苷类药物）造成耳中毒的机制有多种学说，但它们只要吸收入血到达内耳或经中耳局部应用到达内耳，就可造成内耳的毒性损害。因此口服庆大霉素也要当心毒性，特别是小儿。 病例二： 张先生夏天被查出患有胃窦炎，社区医生建议他口服庆大霉素治疗。他连续口服庆大霉素60天,结果胃窦炎没有治愈，却出现了眩晕、恶心、站立不稳等症状。耳鼻喉科主任检查发现，他内耳的前庭半规管阻塞，说是因为庆大霉素损害内耳的听神经所致。听神经包括前庭及耳蜗两个部分，前者管平衡功能，后者管听觉。如果前庭受损，可出现眩晕、站立不稳等表现；耳蜗受损，则会引起耳鸣、听力减退，甚至引起耳聋。 专家指导：在医院门诊或药店，常会碰到一些患者要求购买庆大霉素针剂或片剂口服治疗胃病的。这种疗法虽然有一定效果，但并非十分理想，更应注意的是口服庆大霉素也能招致不良反应。庆大霉素对耳的毒性症状与药物的剂量、用药时间的长短和个人的敏感性等有关。再说，引起胃窦炎和溃疡加重和复发的罪魁祸首幽门螺杆菌，主要栖居于胃高度酸性环境中的黏液凝胶层下面，而口服摄入的庆大霉素很快从胃中排空，致使体内外抗菌效果极不一致，庆大霉素用于口服时，消化道只吸收1％-3％，这个浓度不足以杀灭幽门螺杆菌，长期使用还会发生耳聋。且由于中毒症状是渐进的，早期不容易察觉，当服药后出现了眩晕等症状时，常被误诊为“美尼尔氏综合征”、“颈椎病”，等到确诊为前庭药源性器质性损害时，治疗就相当困难了。 专家提醒，目前已经证明，克拉霉素、阿莫西林、四环素、甲硝唑、替硝唑等都能杀灭幽门螺杆菌。因此，在对胃病患者进行抗幽门螺杆菌时最好不要选用口服庆大霉素。必须选用时一定要注意观察庆大霉素的毒性反应。 |
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