对乙酰氨基酚过量致新生儿肝功能异常

Neonatal liver dysfunction caused by an overdose of paracetamol

1例28 d男性新生儿因喘憋2 d、发热1 d由家人喂服对乙酰氨基酚颗粒半包(约0.125 g),半天后患儿病情加重,体温38.1℃,心率273次/min,呼吸43次/nin。呈点头样呼吸,口唇发绀,三凹征(+),双肺可闻及明显干湿啰音,腹部膨隆,肝肋下6 cm。实验室检查:丙氨酸转氨酶(ALT)979 U/L,天冬氨酸转氨酶(AST)1 661 U/L,碱性磷酸酶(ALP)469 U/L,谷氨酰转肽酶(γ-GT)158 U/L,谷氨酰脱氢酶(GLDH)294 U/L,乳酸脱氢酶(LDH)2 989 U/L,α-羟丁酸脱氢酶(α-HBDH)1 141 U/L。诊断为新生儿肺炎并心力衰竭、急性肝损伤。给予抗炎、抗病毒、保肝降酶等治疗。7 d后复查:ALT 72 U/L,AST 32 U/L,ALP 244 U/L,γ-GT 128 U/L,GLDH 31 U/L,LDH 262 U/L。

A 28-day-old male neonate received paracetamol half a bag （about 0. 125 g） by his parents for 2 days of wheezing and one day of fever. Half a day later, the neonate＇s symptoms worsened. Physical examination showed the foUowing results： temperature 38.1℃, heart rate 273 beats/rain, respi ratory rate 43 breaths/min, nodding-like breathing, lip cyanosis, 3-retraction sign （ ＋ ）, wet and dry rales in bilateral lungs, abdominal distention, and the liver edge palpated at 6 cm below the right costal margin. Laboratory examination showed the following levels： alanine aminotransferase （ALT） 979 U/L, aspartate