咨询描述:我家雪纳瑞有点尿血,刚刚看了你的这个尿血的几种可能,我想到他是吃了我种花的这个化肥中毒了,那么接下来该怎么办啊?
回复总结:狗狗出现尿血的症状,可能的原因有尿路结石和尿路感染。处理办法上,建议最好带狗狗去宠物医院进行尿检,检查狗狗尿液中有没有炎性细胞、细菌或者结石结晶,然后再对症治疗。如果暂时不方便去宠物医院就诊,建议给狗狗口服含有阿莫西林克拉维酸钾成分的药物,控制炎症,同时配合服用溶解尿中结石的药物。另外,建议给狗狗大量饮水,一天饮水量不低于500ml。
问题大致一样,细节不同?
陆文健
执业兽医师
但仅仅根据您目前提供的信息,还不能做出进一步的判断。我还有几个问题需要向您核实一下:
1、狗狗年龄、体重、公母、有无免疫、有无驱虫?
2、狗狗尿血有多长时间了?是小便开始时有血?还是整个小便都有血?尿液是什么颜色?
3、狗狗有没有尿频、尿急的症状?
4、狗狗精神状态和食欲怎么样?有没有发烧等症状?
5、您使用的化肥是什么化肥?什么成分?使用这个化肥有多长时间了?您是怎么怀疑化肥中毒的?
以上这些情况您仔细回忆后详细的描述给我,对我给狗狗目前情况做判断以及制定治疗方案有非常大的帮助,感谢您的配合。
小狗7岁15公斤公狗都做过免疫,做过驱虫,尿血,是今天上午第1次发现,宠物店洗完澡出来拉了一次尿,正常,拉第2次尿的时候,我发现里面是带有血,尿液是浅黄色。尿急昨晚有一点症状,尿在家里了,精神状态和食欲都正常,没有发烧。吃化肥是我夫人前天晚上看到他在那边啃我那个化肥小袋子,嘴巴上都是黑的,化肥成分就写的是生物有机肥我的我的这个小化肥是自己家里种蔬菜用的,应该没什么毒性。
陆文健
执业兽医师
有些有毒物质中毒,比如葡萄中毒,一些重金属元素中毒等是有可能造成肾脏损伤,导致尿中带血,而且如果是由于中毒原因造成中毒,小便颜色一般是咖啡色,整个小便都会带血液,并且精神状态和食欲也是会有明显的影响。
如果您使用的化肥确定是生物有机肥的话,一般不会导致狗狗中毒。
狗狗第二次小便带血是什么颜色的?部分尿液带血,还是整个尿液带血?尽可能详细描述一下,或者如果有照片的话发给我看一下。
化肥是自家种蔬菜用的有机肥应该问题不大,他第二次尿是浅黄色,是部份尿液带有血。
陆文健
执业兽医师
根据您的描述提到的,昨晚狗狗有尿急,今天上午第二次小便尿液中部分带血,这种情况可以排除中毒问题。可能的原因有两种,一是尿路结石;二是尿路感染。虽然尿路结石和尿路感染都可能导致尿中带血,但尿路结石更容易造成小便出血。如果要确诊需要进行尿检,检查尿中有没有炎性细胞、细菌、或者结石结晶。
目前我给您的建议治疗方案是:
1、口服阿莫西林克拉维酸钾片,抗菌消炎,控制炎症;
2、口服对于尿中结石容易溶解的药物,比如***;
3、给狗狗大量饮水,一天饮水量不低于500ml。
以上建议供您参考,下面我给您的狗狗开个处方供您参考。
陆文健
执业兽医师
根据狗狗尿中带血,怀疑尿路结石或者尿路感染的情况,我给它开个处方。处方里面的:
1、***,抗菌消炎,治疗尿路感染;
2、***,尿路结石和尿路炎症的辅助治疗。
您可以根据需求自行选择购买。
建议处方:
1、***(阿莫西林克拉维酸钾片),250mg×10片/板,口服一次1片,一天2次,连用5天;
2、**** ,60ml/瓶,口服一次4ml,一天2次,连用5-7天。
陆文健
执业兽医师
需要注意:
1、给狗狗大量饮水,一天饮水量不低于500ml。
2、请用药5天后复诊,根据您的狗狗恢复的情况再来考虑是否需要调整治疗方案,有问题可随时在线联系。
医生建议及处方根据当前病情给出,仅适用于本次问诊
蘑菇宠医处方笺
用法用量需根据患宠的年龄、体重等信息开具,此处方暂不展示
{"348676":{"id":348676,"case_id":40496,"user_id":1388751,"to_user_id":2020986,"type":3,"content":"根据狗狗尿中带血,怀疑尿路结石或者尿路感染的情况,我给它开个处方。处方里面的:\n1、***,抗菌消炎,治疗尿路感染;\n2、***,尿路结石和尿路炎症的辅助治疗。\n您可以根据需求自行选择购买。\n\n建议处方:\n1、***(阿莫西林克拉维酸钾片),250mg×10片\/板,口服一次1片,一天2次,连用5天;\n2、**** ,60ml\/瓶,口服一次4ml,一天2次,连用5-7天。","media":{"images":{},"videos":{},"business_params":{"prescription_id":114734}},"is_doctor":1,"status":1,"created_at":"2022-06-15 15:15:00","show_rx":true,"rx_info":{"id":114734,"rx_no":2.02206151514225e+24,"user_id":2020986,"doctor_user_id":1388751,"is_independent":0,"case_id":2777397,"pet_info":{"pet_id":302302,"pet_name":"雪纳瑞","pet_nickname":"查理","pet_gender":3,"pet_birth":"7-5","pet_weight":15,"pet_vaccination_status":1,"pet_in_insect_repellent_status":1,"pet_out_insect_repellent_status":1,"pet_age_format":"7岁5个月"},"diagnose":"怀疑尿路结石或者尿路感染导致尿中带血","signature":"","deadline":null,"status":1,"send_status":1,"use_status":0,"created_at":"2022-06-15 15:14:22","updated_at":"2022-06-15 15:15:00","deleted_at":null,"from_source":"online","template_id":0,"drug_data":{"0":{"id":32828,"prescription_id":114734,"doctor_user_id":1388751,"product_id":709,"product_sku_id":752,"dose":1,"dose_unit":"片","use_method":"口服","frequency":"每天2次","days":5,"number":1,"remark":"饭后,或者和食物混合后服用","created_at":"2022-06-15 15:14:22","updated_at":"2022-06-15 15:14:22","product_info":{"id":709,"hash_id":"lazo6rxWXWpOqD9E","class_ids":{"0":1,"1":2},"category_ids":{"2":163},"is_drugstore":1,"is_prescription":1,"drug_instruction_id":5,"sell_point":"速诺(阿莫西林克拉维酸钾片)250mg","title":"辉瑞速诺(阿莫西林克拉维酸钾片)250mg×10片\/板","recommend_reason":{"0":"适用于宠物由敏感细菌引起的皮肤及软组织感染、呼吸道感染","1":"治疗宠物革兰氏阴性和革兰氏阳性敏感细菌的感染","2":"用于肠炎及其他感染,如中耳炎、骨髓炎、败血症、腹膜炎和手术后感染"},"baike_guide_text":"","baike_article_hash_id":"","advword":"呼吸道感染,肠炎,腹泻,便血,真菌感染,猫癣,脓皮症","spec_data":{"1":{"name":"规格","option_data":{"0":{"name":"250mg规格1板"}}}},"cover":"https:\/\/cdn.moguvet.com\/shop\/2021\/12\/0c5606ffe97cfdbe080e7c31980a047d.jpeg","images":{},"attr_data":{},"content":"","supplier_id":1,"transport_id":1,"min_price":98,"max_price":98,"sale_count":677,"tags":"","sort":0,"status":1,"delete_status":0,"created_at":"2021-12-16 15:43:15","updated_at":"2024-11-24 10:15:11","ins":{"id":5,"hash_id":"","class_ids":"[\u00221\u0022,\u00222\u0022]","title":"","common_name":"阿莫西林克拉维酸钾片","trade_name":"速诺","en_name":"Synulox Palatable Tablets","brand_name":"辉瑞","is_prescription":1,"cover":"\/drug\/2020\/10\/b4e16954b19120b0d777543dde23b1da.JPG","specification":"250mg×10片×10板\/盒","reference_price":2200,"component":"阿莫西林和克拉维酸钾","indication":"适用于犬由敏感细菌引起的各种感染,及治疗犬革兰氏阴性和革兰氏阳性敏感细菌的感染。\n1、如皮肤及软组织感染脓性皮炎、脓肿和肛腺炎、蜂窝组织炎、伤口感染、腹内脓毒症等。\n2、牙感染(牙龈炎)。\n3、尿道感染,如膀胱炎、尿道炎、肾盂肾炎、前列腺炎、盆腔炎、淋病奈瑟菌尿路感染及软性下疳等。\n4、呼吸道感染,如鼻窦炎、扁桃体炎、咽炎、急慢性支气管炎、慢性支气管炎急性发作、肺炎、肺脓肿和支气管合并感染。\n5、肠炎及其他感染,如中耳炎、骨髓炎、败血症、腹膜炎和手术后感染等。","usage_dosage":"口服。每天吃2次,连用5-7天。每次用量如下:\n体重9-12kg,吃0.5片;\n体重13-15kg,吃0.75片;\n体重16-22kg,吃1片;\n体重23-30kg,吃1.5片;\n体重31-40kg,吃2片;\n体重41kg及以上请购买同品500mg规格的产品。\n\n注:一些慢性感染(慢性皮炎、慢性膀胱炎和慢性呼吸道感染)的治疗可连用10-28天。","contraindication":"1. 仓鼠、豚鼠、沙鼠、灰鼠和家兔禁用。\n2. 其他草食动物慎用。\n3.对青霉素过敏者禁止接触本品。","adverse_reaction":"1.恶心、腹泻和皮肤丘疹是最常见的不良反应。\n2.本品为青霉素类药物,若出现过敏反应可使用肾上腺素治疗。","attention":"1.不要对病情严重的动物使用口服抗生素,因其胃肠道吸收可能不可靠,这些患病动物可能需要静脉注射剂。\n2.避免在对其他β-内酰胺类抗菌药(包含头孢菌素类)有过敏反应的动物使用。\n3.片剂由防潮箔包裹,给药前不要取出。\n4.对青霉素过敏者如果不慎接触,应该立刻去找医生救助。\n5.孕畜慎用。\n4.使用后请洗手。\n5.不要让小孩接触到此产品。","interaction":"1.避免同时使用抑菌性抗生素(如四环素、红霉素)。\n2.不要给鸟类同时使用别嘌呤醇、β-内酰胺和氨基糖苷类抗菌剂在体内有协同作用。\n3.本品和氨苄西林有完全交叉耐药性,与青霉素类和头孢菌素类有交叉耐药性。","approval_no":"(2018)外兽药证字11号","storage_method":"密封,在凉暗干燥处保存。","validity":"2年","manufacturer":"意大利豪普特制药厂(Haupt Pharma Latina S.R.L)","status":1,"created_at":"2020-10-23 12:09:57","updated_at":"2020-10-23 16:00:00"}},"product_sku_info":{"id":752,"product_id":709,"title":"辉瑞速诺(阿莫西林克拉维酸钾片)250mg×10片\/板","advword":null,"price":98,"market_price":119,"cost_price":0,"stock":726,"stock_alarm":10,"spec_data":{"1":{"name":"规格","option":"250mg规格1板"}},"cover":null,"thumb":"","sale_count":715,"status":1,"delete_status":0,"cloud_repo_id":0,"cloud_repo_goods_id":"","sort":1,"created_at":"2021-12-16 15:43:15","updated_at":"2024-11-24 19:59:41"}},"1":{"id":32829,"prescription_id":114734,"doctor_user_id":1388751,"product_id":756,"product_sku_id":798,"dose":4,"dose_unit":"ml","use_method":"口服","frequency":"每天2次","days":7,"number":1,"remark":"混饲或直接饲喂","created_at":"2022-06-15 15:14:22","updated_at":"2022-06-15 15:14:22","product_info":{"id":756,"hash_id":"VjX39W4zeBpQ0bvZ","class_ids":{"0":1,"1":2},"category_ids":{"35":194},"is_drugstore":1,"is_prescription":0,"drug_instruction_id":169,"sell_point":"宠石益 宠物添加剂预混合饲料(UD-130)","title":"蓝特斯宠石益 宠物添加剂预混合饲料(UD-130)60ml\/瓶\/盒","recommend_reason":{"0":"用于犬猫尿路结石","1":"用于犬猫膀胱炎","2":"用于犬猫泌尿道炎症、泌尿道综合症等"},"baike_guide_text":"","baike_article_hash_id":"","advword":"泌尿道,结石,感染,膀胱炎","spec_data":{"1":{"name":"规格","option_data":{"0":{"name":"60ml"}}}},"cover":"https:\/\/cdn.moguvet.com\/shop\/2024\/01\/895d6f0d9fa345292dc5a725a1f5b086.jpg","images":{},"attr_data":{},"content":"","supplier_id":1,"transport_id":1,"min_price":98,"max_price":98,"sale_count":62,"tags":"","sort":0,"status":1,"delete_status":0,"created_at":"2021-12-17 17:54:06","updated_at":"2024-11-11 09:35:45","ins":{"id":169,"hash_id":"","class_ids":"[1,2]","title":"宠石益宠物添加剂预混合饲料(UD-100)","common_name":"宠物添加剂预混合饲料(UD-100)","trade_name":"宠石益","en_name":"Pet additive premixed feed(UD-100)","brand_name":"蓝特斯","is_prescription":0,"cover":"\/drug\/2021\/03\/94a2e7dfcd38a1c5614573330ff221f3.jpg","specification":"60ml\/瓶","reference_price":118,"component":"柠檬酸钾,葡萄糖胺,乙酰氧肟酸,维生素A,维生素C,维生素E,精氨酸,牛磺酸,蔓越莓等","indication":"1.宠物尿路结石\n2.膀胱炎\n3.泌尿道炎症\n4.泌尿道综合症等","usage_dosage":"犬猫每4kg体重1ml,混饲或直接饲喂。一天2次。用前请摇匀。(新老版本随机发货)","contraindication":"","adverse_reaction":"","attention":"宠物若伴有泌尿道炎症,需配合消炎药使用效果更佳,泌尿道疾病没有办法根治,长期预防可配合处方粮服用,对结晶及小结石也有一定预防效果,详情可咨询在线医生。","interaction":"","approval_no":"苏饲预字(2018)768343","storage_method":"应贮存在干燥、避光、遮风、清洁的环境,不得与有毒有害等污染物混贮。","validity":"24个月","manufacturer":"江苏益品实业有限公司","status":1,"created_at":"2021-03-18 11:01:39","updated_at":"2024-06-01 18:21:53"}},"product_sku_info":{"id":798,"product_id":756,"title":"蓝特斯宠石益 宠物添加剂预混合饲料(UD-130)60ml\/瓶\/盒","advword":null,"price":98,"market_price":120,"cost_price":0,"stock":78,"stock_alarm":10,"spec_data":{"1":{"name":"规格","option":"60ml"}},"cover":"https:\/\/cdn.moguvet.com\/shop\/2024\/01\/c512d1875c2ba0f29337406b27220568.jpg","thumb":"","sale_count":64,"status":1,"delete_status":0,"cloud_repo_id":0,"cloud_repo_goods_id":"","sort":1,"created_at":"2021-12-17 17:54:06","updated_at":"2024-11-20 21:30:02"}}},"drug_data_bak":{"0":{"id":32828,"prescription_id":114734,"doctor_user_id":1388751,"product_id":709,"product_sku_id":752,"dose":1,"dose_unit":"片","use_method":"口服","frequency":"每天2次","days":5,"number":1,"remark":"饭后,或者和食物混合后服用","created_at":"2022-06-15 15:14:22","updated_at":"2022-06-15 15:14:22","product_info":{"id":709,"hash_id":"lazo6rxWXWpOqD9E","class_ids":{"0":1,"1":2},"category_ids":{"2":163},"is_drugstore":1,"is_prescription":1,"drug_instruction_id":5,"sell_point":"速诺(阿莫西林克拉维酸钾片)250mg","title":"辉瑞速诺(阿莫西林克拉维酸钾片)250mg×10片\/板","recommend_reason":{"0":"适用于宠物由敏感细菌引起的皮肤及软组织感染、呼吸道感染","1":"治疗宠物革兰氏阴性和革兰氏阳性敏感细菌的感染","2":"用于肠炎及其他感染,如中耳炎、骨髓炎、败血症、腹膜炎和手术后感染"},"baike_guide_text":"","baike_article_hash_id":"","advword":"呼吸道感染,肠炎,腹泻,便血,真菌感染,猫癣,脓皮症","spec_data":{"1":{"name":"规格","option_data":{"0":{"name":"250mg规格1板"}}}},"cover":"https:\/\/cdn.moguvet.com\/shop\/2021\/12\/0c5606ffe97cfdbe080e7c31980a047d.jpeg","images":{},"attr_data":{},"content":"","supplier_id":1,"transport_id":1,"min_price":98,"max_price":98,"sale_count":677,"tags":"","sort":0,"status":1,"delete_status":0,"created_at":"2021-12-16 15:43:15","updated_at":"2024-11-24 10:15:11","ins":{"id":5,"hash_id":"","class_ids":"[\u00221\u0022,\u00222\u0022]","title":"","common_name":"阿莫西林克拉维酸钾片","trade_name":"速诺","en_name":"Synulox Palatable Tablets","brand_name":"辉瑞","is_prescription":1,"cover":"\/drug\/2020\/10\/b4e16954b19120b0d777543dde23b1da.JPG","specification":"250mg×10片×10板\/盒","reference_price":2200,"component":"阿莫西林和克拉维酸钾","indication":"适用于犬由敏感细菌引起的各种感染,及治疗犬革兰氏阴性和革兰氏阳性敏感细菌的感染。\n1、如皮肤及软组织感染脓性皮炎、脓肿和肛腺炎、蜂窝组织炎、伤口感染、腹内脓毒症等。\n2、牙感染(牙龈炎)。\n3、尿道感染,如膀胱炎、尿道炎、肾盂肾炎、前列腺炎、盆腔炎、淋病奈瑟菌尿路感染及软性下疳等。\n4、呼吸道感染,如鼻窦炎、扁桃体炎、咽炎、急慢性支气管炎、慢性支气管炎急性发作、肺炎、肺脓肿和支气管合并感染。\n5、肠炎及其他感染,如中耳炎、骨髓炎、败血症、腹膜炎和手术后感染等。","usage_dosage":"口服。每天吃2次,连用5-7天。每次用量如下:\n体重9-12kg,吃0.5片;\n体重13-15kg,吃0.75片;\n体重16-22kg,吃1片;\n体重23-30kg,吃1.5片;\n体重31-40kg,吃2片;\n体重41kg及以上请购买同品500mg规格的产品。\n\n注:一些慢性感染(慢性皮炎、慢性膀胱炎和慢性呼吸道感染)的治疗可连用10-28天。","contraindication":"1. 仓鼠、豚鼠、沙鼠、灰鼠和家兔禁用。\n2. 其他草食动物慎用。\n3.对青霉素过敏者禁止接触本品。","adverse_reaction":"1.恶心、腹泻和皮肤丘疹是最常见的不良反应。\n2.本品为青霉素类药物,若出现过敏反应可使用肾上腺素治疗。","attention":"1.不要对病情严重的动物使用口服抗生素,因其胃肠道吸收可能不可靠,这些患病动物可能需要静脉注射剂。\n2.避免在对其他β-内酰胺类抗菌药(包含头孢菌素类)有过敏反应的动物使用。\n3.片剂由防潮箔包裹,给药前不要取出。\n4.对青霉素过敏者如果不慎接触,应该立刻去找医生救助。\n5.孕畜慎用。\n4.使用后请洗手。\n5.不要让小孩接触到此产品。","interaction":"1.避免同时使用抑菌性抗生素(如四环素、红霉素)。\n2.不要给鸟类同时使用别嘌呤醇、β-内酰胺和氨基糖苷类抗菌剂在体内有协同作用。\n3.本品和氨苄西林有完全交叉耐药性,与青霉素类和头孢菌素类有交叉耐药性。","approval_no":"(2018)外兽药证字11号","storage_method":"密封,在凉暗干燥处保存。","validity":"2年","manufacturer":"意大利豪普特制药厂(Haupt Pharma Latina S.R.L)","status":1,"created_at":"2020-10-23 12:09:57","updated_at":"2020-10-23 16:00:00"}},"product_sku_info":{"id":752,"product_id":709,"title":"辉瑞速诺(阿莫西林克拉维酸钾片)250mg×10片\/板","advword":null,"price":98,"market_price":119,"cost_price":0,"stock":726,"stock_alarm":10,"spec_data":{"1":{"name":"规格","option":"250mg规格1板"}},"cover":null,"thumb":"","sale_count":715,"status":1,"delete_status":0,"cloud_repo_id":0,"cloud_repo_goods_id":"","sort":1,"created_at":"2021-12-16 15:43:15","updated_at":"2024-11-24 19:59:41"}},"1":{"id":32829,"prescription_id":114734,"doctor_user_id":1388751,"product_id":756,"product_sku_id":798,"dose":4,"dose_unit":"ml","use_method":"口服","frequency":"每天2次","days":7,"number":1,"remark":"混饲或直接饲喂","created_at":"2022-06-15 15:14:22","updated_at":"2022-06-15 15:14:22","product_info":{"id":756,"hash_id":"VjX39W4zeBpQ0bvZ","class_ids":{"0":1,"1":2},"category_ids":{"35":194},"is_drugstore":1,"is_prescription":0,"drug_instruction_id":169,"sell_point":"宠石益 宠物添加剂预混合饲料(UD-130)","title":"蓝特斯宠石益 宠物添加剂预混合饲料(UD-130)60ml\/瓶\/盒","recommend_reason":{"0":"用于犬猫尿路结石","1":"用于犬猫膀胱炎","2":"用于犬猫泌尿道炎症、泌尿道综合症等"},"baike_guide_text":"","baike_article_hash_id":"","advword":"泌尿道,结石,感染,膀胱炎","spec_data":{"1":{"name":"规格","option_data":{"0":{"name":"60ml"}}}},"cover":"https:\/\/cdn.moguvet.com\/shop\/2024\/01\/895d6f0d9fa345292dc5a725a1f5b086.jpg","images":{},"attr_data":{},"content":"","supplier_id":1,"transport_id":1,"min_price":98,"max_price":98,"sale_count":62,"tags":"","sort":0,"status":1,"delete_status":0,"created_at":"2021-12-17 17:54:06","updated_at":"2024-11-11 09:35:45","ins":{"id":169,"hash_id":"","class_ids":"[1,2]","title":"宠石益宠物添加剂预混合饲料(UD-100)","common_name":"宠物添加剂预混合饲料(UD-100)","trade_name":"宠石益","en_name":"Pet additive premixed feed(UD-100)","brand_name":"蓝特斯","is_prescription":0,"cover":"\/drug\/2021\/03\/94a2e7dfcd38a1c5614573330ff221f3.jpg","specification":"60ml\/瓶","reference_price":118,"component":"柠檬酸钾,葡萄糖胺,乙酰氧肟酸,维生素A,维生素C,维生素E,精氨酸,牛磺酸,蔓越莓等","indication":"1.宠物尿路结石\n2.膀胱炎\n3.泌尿道炎症\n4.泌尿道综合症等","usage_dosage":"犬猫每4kg体重1ml,混饲或直接饲喂。一天2次。用前请摇匀。(新老版本随机发货)","contraindication":"","adverse_reaction":"","attention":"宠物若伴有泌尿道炎症,需配合消炎药使用效果更佳,泌尿道疾病没有办法根治,长期预防可配合处方粮服用,对结晶及小结石也有一定预防效果,详情可咨询在线医生。","interaction":"","approval_no":"苏饲预字(2018)768343","storage_method":"应贮存在干燥、避光、遮风、清洁的环境,不得与有毒有害等污染物混贮。","validity":"24个月","manufacturer":"江苏益品实业有限公司","status":1,"created_at":"2021-03-18 11:01:39","updated_at":"2024-06-01 18:21:53"}},"product_sku_info":{"id":798,"product_id":756,"title":"蓝特斯宠石益 宠物添加剂预混合饲料(UD-130)60ml\/瓶\/盒","advword":null,"price":98,"market_price":120,"cost_price":0,"stock":78,"stock_alarm":10,"spec_data":{"1":{"name":"规格","option":"60ml"}},"cover":"https:\/\/cdn.moguvet.com\/shop\/2024\/01\/c512d1875c2ba0f29337406b27220568.jpg","thumb":"","sale_count":64,"status":1,"delete_status":0,"cloud_repo_id":0,"cloud_repo_goods_id":"","sort":1,"created_at":"2021-12-17 17:54:06","updated_at":"2024-11-20 21:30:02"}}}}}}
微信扫一扫
立即问宠医