水杨酸酯或对乙酰氨基酚中毒的体外治疗——有作用吗？

Extracorporeal treatment of salicylate or acetaminophen poisoning--is there a role?

作者信息

Winchester J F, Gelfand M C, Helliwell M, Vale J A, Goulding R, Schreiner G E

出版信息

Arch Intern Med. 1981 Feb 23;141(3 Spec No):370-4. doi: 10.1001/archinte.141.3.370.

DOI:10.1001/archinte.141.3.370

Abstract

Hemodialysis or sorbent hemoperfusion has been used in the management of clinical overdose of salicylates or acetaminophen. Hemodialysis offers considerable benefit in severe salicylate poisoning and is preferred to hemoperfusion or peritoneal dialysis, since it more rapidly corrects acid-base and electrolyte abnormalities than does hemoperfusion, and since it is clearly more efficient than is peritoneal dialysis for the removal of salicylates. Charcoal hemoperfusion in animal studies and hemodialysis in man have been shown to accelerate acetaminophen elimination from the body. Hemodialysis and hemoperfusion are of questionable benefit in clinical acetaminophen overdose. However, our clinical experience to date with charcoal hemoperfusion in "late" acetaminophen overdose has been associated with a less notable increase in liver enzyme concentrations in comparison with results of retrospective studies of series of patients treated or not treated with sulfhydryl donors.

摘要

血液透析或吸附性血液灌流已用于临床水杨酸类或对乙酰氨基酚过量中毒的治疗。血液透析对严重水杨酸中毒有显著疗效，相较于血液灌流或腹膜透析更为可取，因为它比血液灌流能更快地纠正酸碱及电解质异常，且在清除水杨酸方面明显比腹膜透析更有效。动物研究中的活性炭血液灌流及人体中的血液透析已证明可加速对乙酰氨基酚从体内清除。血液透析和血液灌流对临床对乙酰氨基酚过量中毒的益处存疑。然而，我们目前对“晚期”对乙酰氨基酚过量中毒患者进行活性炭血液灌流的临床经验显示，与接受或未接受巯基供体治疗的患者系列回顾性研究结果相比，肝酶浓度升高不太明显。