氨酚双氢可待因过量致严重肝损伤

Severe liver injury due to overdose of paracetamol and dihydrocodeine tartrate

1例29岁女性患者因宫颈妊娠和阴道出血行清宫术和子宫动脉栓塞术,术前体格检查示肝功能正常。因术后疼痛,患者20 h内自行口服氨酚双氢可待因片20片。服药第2天实验室检查示丙氨酸转氨酶(ALT)263 U/L,天冬氨酸转氨酶(AST)226 U/L,给予葡醛内酯100 mg,3次/d口服。第3天患者诉恶心,呕吐,进食少。第4天实验室检查示ALT1 128 U/L,AST1 006 U/L,总胆红素44.7μmol/L。诊断为氨酚双氢可待因所致严重肝损伤,给予多烯磷酸酯胆碱930 mg入5%葡萄糖注射液100 ml、复方甘草酸苷注射液80 ml+氯化钠注射液250 ml、还原型谷胱甘肽钠1.8 g入5%葡萄糖注射液100 ml,1次/d静脉滴注。保肝治疗第9天患者饮食恢复正常,恶心、呕吐等症状消失,实验室检查示ALT 404 U/L,AST 32 U/L;第21天ALT 34 U/L,AST 18 U/L。

A 29-year-old woman underwent curettage and uterine artery embolization for cervical pregnancy and colporrhagia. Her physical and laboratory examination before operation showed normal liver function. The patient received paracetamol and dihydrocodeine tartrate 20 pills within 20 hours by herself because of postoperative pain. Laboratory tests on day 2 of drug use revealed the following levels ： alanine aminotransferase （ALT） 263 U/L, aspartate aminotransferase （AST） 226 U/L. She was given tabellae glucurolactone 100 mg three times daily. On day 3 of drug use the patient developed nausea, vomit, and poor appetite. Laboratory tests on 4 day of drug use revealed the following levels： ALT 1 128 U/L, AST 1 006 U/L, total bilirubin 44.7 mot/L. The patieμnt was diagnosed as severe liver injury due to overdose of paracetamol and dihydrocodeine tartrate. She received an IV infusion of polyene phosphatidyl choline 930 mg dissoloved in 5% glucose injection 100 ml, compound glycyrrhrzin injection 80 ml plus 0. 9% sodium chloride 250 ml, and reduced glutathione sodium 1.8 g dissoloved in 5% glucose injection 100 ml oncedaily. On day 9 of treatment of liver the patient＇s diet return to normal, the symptoms of nausea and vomit were disappeared. Laboratory tests showed the following levels： ALT 404 U/L, AST 32 U/L. On 21 day of treatment of liver, laboratory tests showed the following levels： ALT 34 U/L,AST 18 U/L.