Weber P, Scheurlen M, Irkin I, Viebahn R, Schareck W, Becker W, de Groot H, Lauchart W
Abteilung I, Medizinischen Klinik, Tübingen.
Zentralbl Chir. 1994;119(5):305-8.
The risk for developing acute liver failure after halothane exposition was calculated between 1:8,000 and 1:36,000. The case report given on a 22 year old man with halothane-induced hepatic failure is unusual, because the typical risk factors as age over 40, female sex, obesity, and previous exposure to halothane were not present. Two days after exposure to halothane the patient suffered acute liver failure with severe coagulopathy (factor V = 5% activity), and encephalopathy grade IV complicated by renal failure and respiratory insufficiency. Maximal increases of enzymes in blood were AST 3900 U/L, ALT 2570 U/L, LDH 10600 U/L. After six days the patient underwent liver transplantation with complete anuria and instable circulation. Explanted liver showed massive necrosis (70% of parenchyma) and fatty changes. The liver transplant had immediately a good function and renal failure resolved within three days. In the follow-up of 3 1/2 years the patient suffered no further complications. Culturing the patient's lymphocytes in the lymphocyte transformation test a strong reaction could be detected with a stimulatory index of 20. Maximal proliferation was observed when lymphocytes were incubated with plasma metabolites of a volunteer drawn 120 minutes after anesthesia with halothane was started.
氟烷暴露后发生急性肝衰竭的风险估计在1:8000至1:36000之间。这份关于一名22岁男性氟烷诱导性肝衰竭的病例报告很不寻常，因为典型的风险因素如年龄超过40岁、女性、肥胖以及既往氟烷暴露史均不存在。氟烷暴露两天后，患者出现急性肝衰竭伴严重凝血功能障碍（因子V活性为5%）及IV级肝性脑病，并伴有肾衰竭和呼吸功能不全。血液中酶的最大升高值为：谷草转氨酶（AST）3900 U/L、谷丙转氨酶（ALT）2570 U/L、乳酸脱氢酶（LDH）10600 U/L。六天后，患者在无尿且循环不稳定的情况下接受了肝移植。切除的肝脏显示大片坏死（实质的70%）及脂肪变性。肝移植后肝功能立即良好，肾衰竭在三天内得到缓解。在3年半的随访中，患者未出现进一步并发症。在淋巴细胞转化试验中培养患者的淋巴细胞时，可检测到强烈反应，刺激指数为20。当淋巴细胞与一名志愿者在氟烷麻醉开始120分钟后采集的血浆代谢产物一起孵育时，观察到最大增殖。
