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[肝移植作为对乙酰氨基酚中毒的治疗方法]

[Liver transplantation as treatment for acetaminophen poisoning].

作者信息

Cervantes José G, Gasque Rodrigo A, Lenz Marcelo E, Barbero Manuel, Navarro Lucía, Roca Ignacio, Cairo Fernando, Mattera Francisco J, Quiñonez Emilio G

机构信息

Unidad de Cirugía Hepatobiliar Compleja, Pancreática y Trasplante Hepático, Servicio de Trasplante de Órganos Sólidos, Hospital de Alta Complejidad El Cruce, Florencio Varela, Buenos Aires, Argentina. E-mail:

Unidad de Cirugía Hepatobiliar Compleja, Pancreática y Trasplante Hepático, Servicio de Trasplante de Órganos Sólidos, Hospital de Alta Complejidad El Cruce, Florencio Varela, Buenos Aires, Argentina.

出版信息

Medicina (B Aires). 2024;84(3):588-591.

Abstract

Acetaminophen is a commonly used analgesic and antipyretic drug, which has experienced an increase in its consumption in recent years in our environment. There has also been an increase in the number of accidental and intentional overdoses that were treated by the health system. Its toxicity is dose-dependent and can cause fulminant liver failure, becoming one of the main reasons for liver transplantation in English-speaking countries. The case of a 28-year-old woman with a history of major depression and five previous suicide attempts, who deliberately ingested a significant amount of paracetamol tablets, is here presented. She developed fulminant liver failure and metabolic acidosis, for which she underwent an emergency liver transplant due to the severity of her condition, from which she evolved favorably. The decision to perform a liver transplant in serious cases like this and under a condition of severe psychiatric vulnerability is challenging and must be carefully considered. This particular case illustrates the importance of multidisciplinary care including psychiatric evaluation in patients with acetaminophen poisoning.

摘要

对乙酰氨基酚是一种常用的解热镇痛药,近年来在我们所处的环境中其消费量有所增加。卫生系统治疗的意外和故意过量用药病例数量也有所增加。其毒性具有剂量依赖性,可导致暴发性肝衰竭,成为英语国家肝移植的主要原因之一。本文介绍了一名28岁女性的病例,她有重度抑郁症病史且曾有过五次自杀未遂,故意摄入了大量扑热息痛片。她出现了暴发性肝衰竭和代谢性酸中毒,由于病情严重,接受了紧急肝移植,术后恢复良好。在这种严重病例且存在严重精神脆弱状况下决定进行肝移植具有挑战性,必须仔细考虑。这个特殊病例说明了多学科护理的重要性,包括对乙酰氨基酚中毒患者进行精神科评估。

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