Janes J, Routledge P A
Welsh National Poisons Unit, Llandough Hospital, Penarth, South Glamorgan, Wales.
Drug Saf. 1992 May-Jun;7(3):170-7. doi: 10.2165/00002018-199207030-00002.
Paracetamol (acetaminophen) poisoning accounts for almost a third of admissions to our district poisons unit, and is the commonest cause of death in such patients. Antidotal treatment may be effective up to 10h after overdose with oral methionine or up to 24h with acetylcysteine (not 15h as previously suggested for the latter). Patients taking paracetamol overdose while also receiving drugs which induce hepatic enzymes are more susceptible to liver damage, and antidotal treatment may be necessary at lower plasma paracetamol concentrations (50% of the normal treatment line). As survival following liver transplantation is now increasing, it is important to identify early prognostic indicators in fulminant hepatic failure, so that those patients with a high chance of fatal outcome can be considered for transplantation. Useful indicators are the presence of acidosis, marked prolongation of prothrombin time or a continued rise in prothrombin time on day 4 after the overdose. There is no evidence that paracetamol or acetylcysteine are teratogenic in pregnancy. Delays in administering acetylcysteine after paracetamol poisoning in pregnancy have been shown to increase the risk of spontaneous abortion and fetal death. Thus, acetylcysteine should be started as early as possible where treatment is indicated.
对乙酰氨基酚中毒占我们地区中毒治疗中心收治病例的近三分之一，是此类患者最常见的死亡原因。口服蛋氨酸进行解毒治疗在过量服药后10小时内可能有效，使用乙酰半胱氨酸则在24小时内有效（并非如之前所建议的后者为15小时）。服用对乙酰氨基酚过量的同时还接受诱导肝酶药物的患者更容易发生肝损伤，在血浆对乙酰氨基酚浓度较低时（正常治疗线的50%）可能就需要进行解毒治疗。鉴于肝移植后的生存率目前正在提高，识别暴发性肝衰竭早期预后指标很重要，这样就可以考虑对那些有高死亡风险的患者进行移植。有用的指标包括酸中毒的存在、凝血酶原时间显著延长或过量服药后第4天凝血酶原时间持续上升。没有证据表明对乙酰氨基酚或乙酰半胱氨酸在孕期具有致畸性。已表明孕期对乙酰氨基酚中毒后延迟给予乙酰半胱氨酸会增加自然流产和胎儿死亡的风险。因此，在有治疗指征时应尽早开始使用乙酰半胱氨酸。
