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成人对乙酰氨基酚(扑热息痛)中毒：病理生理、临床表现和诊断

Authors
Michael J Burns, MD
Scott L Friedman, MD
Anne M Larson, MD, FACP, FAASLD, AGAF
Section Editors
Stephen J Traub, MD
Michele M Burns, MD, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM
Translators
万智, 副主任医师

引言

从1955年对乙酰氨基酚[N-乙酰-对-氨基苯酚(N-acetyl-p-aminophenol, APAP)，扑热息痛]在临床上使用以来，该药已成为在美国应用最广泛的解热镇痛药。它是世界各地使用的数百种非处方药和处方药的成分。

虽然该药物在常规治疗剂量下使用相当安全，但自1966年，已发现对乙酰氨基酚过量服用可导致致命性和非致命性肝坏死[1]。人们怀疑，对于某些易感个体(如酗酒者)，哪怕是重复的治疗剂量或轻微过度剂量都可能有肝毒性[2-7]。在美国，对乙酰氨基酚中毒已成为急性肝功能衰竭最常见的病因[8-12]。

对乙酰氨基酚中毒的病理生理、临床表现和诊断将总结在此。对乙酰氨基酚中毒的治疗将单独讨论。 (参见“成人对乙酰氨基酚(扑热息痛)中毒的治疗”)

流行病学

对乙酰氨基酚广泛普及，普通人常常低估其毒性。此外，相当比例的患者由于误解剂量指导或没有意识到对乙酰氨基酚存在于他们正在使用的不止一种药物中，从而摄取了过量的对乙酰氨基酚[13]。这些错误最常发生于阅读能力有限或大剂量使用对乙酰氨基酚的患者中。

并不奇怪，对乙酰氨基酚仍然是美国和许多其他国家药物过量和药物过量相关肝功能衰竭及死亡的一个主要原因[8,14]。为追踪美国急性肝功能衰竭病例而建立的国家网络发现，几乎一半的急性肝功能衰竭发作都是对乙酰氨基酚引起的，而且这些病例在所有急性肝功能衰竭事件中所占的比例似乎在逐渐增加[9,15]。来源于该组织的数据显示，故意(自杀性)和非故意(慢性)中毒在对乙酰氨基酚相关肝功能衰竭病例中各占一半[9]。

                              

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-21.
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