Gazzard B G, Widdop B, Davis M, Hughes R D, Goulding R, Williams R
Postgrad Med J. 1977 May;53(619):243-7. doi: 10.1136/pgmj.53.619.243.
Clinical and biochemical data obtained from 163 patients who had taken an overdose of paracetamol were examined to determine which factors or measurements were of value in predicting the severity of ensuing liver damage early after ingestion of tablets. Although the overall severity of hepatic necrosis was found to increase with the dose of paracetamol ingested, correlation was not sufficiently close to provide an accurate prognostic index in individuals. Severe hepatic damage was less likely if the patient had vomited or had a stomach wash-out within 6 hr of overdose. The plasma concentrations of paracetamol, measured at known times after overdose, distinguished those who developed hepatic dysfunction from those who did not, but there was a poor correlation, particularly in the first 6 hr after ingestion of tablets, between these values and the severity of ensuing liver damage. Estimates of early plasma paracetamol half-lives from three or more samples taken within 4 hr of admission showed that all patients developing moderate or severe liver damage had half-lives greater than 4 hr, but this was also the case in nearly one-third of those with minimal liver lesions only. It is concluded that there is no completely reliable early prognostic test for individual patients with paracetamol overdose. If each patient is selected for treatment with cysteamine (mercaptamine) or other agents on the basis of plasma paracetamol levels, up to 30% may receive this agent who are at risk from trivial hepatic damage only.
对163例过量服用扑热息痛的患者的临床和生化数据进行了检查，以确定哪些因素或测量值对预测服药后早期肝损伤的严重程度有价值。尽管发现肝坏死的总体严重程度随扑热息痛摄入量的增加而增加，但相关性不够紧密，无法为个体提供准确的预后指标。如果患者在过量服药后6小时内呕吐或洗胃，发生严重肝损伤的可能性较小。在过量服药后的已知时间测量扑热息痛的血浆浓度，可以区分出发生肝功能障碍的患者和未发生的患者，但这些值与随后肝损伤的严重程度之间的相关性较差，尤其是在服药后的前6小时。对入院后4小时内采集的三个或更多样本的早期血浆扑热息痛半衰期的估计表明，所有发生中度或重度肝损伤的患者半衰期均大于4小时，但仅有轻微肝损伤的患者中近三分之一也是如此。得出的结论是，对于过量服用扑热息痛的个体患者，没有完全可靠的早期预后检测方法。如果根据血浆扑热息痛水平为每位患者选择用半胱胺（巯基乙胺）或其他药物进行治疗，那么高达30%可能仅因轻微肝损伤而有风险的患者会接受这种药物治疗。
