静脉应用胺碘酮致急性严重肝损伤

Acute and serious liver injury induced by intravenous amiodarone

1例71岁男性患者于起搏器植入术后静脉注射胺碘酮150 mg,接续胺碘酮600 mg持续静脉微量泵入。术前肝功能正常。用药第3天,患者出现恶心、呕吐、皮肤黄染,丙氨酸转氨酶(ALT)2 954 U/L,天冬氨酸转氨酶(AST)156 U/L,总胆红素(TBil)56.4μmol/L,直接胆红素(DBil)37.4μmol/L,间接胆红素(IBil)19.0μmol/L。停用胺碘酮,并行保肝治疗。停用胺碘酮第5天,ALT965 U/L,AST 296 U/L,TBil 35.6μmol/L,DBil 21.3μmol/L,IBil 14.3μmol/L;第15天,ALT 37 U/L,AST 27 U/L,TBil 14.0μmol/L,DBil 6.7μmol/L,IBil 7.3μmol/L。

A 71-year-old male patient received intravenous amiodarone 150 mg followed by amiodarone 600 mg with continuous microdose venous pump after pacemaker implantation.Liver function was normal before the operation.On day 3 of drug use,the patient presented with nausea,vomiting,and yellowish skin with a alanine aminotransferase （ALT） value of 2 954 U/L,a aspartate aminotransferase （AST） value of 156 U/L,a total bilirubin （TBil） value of 56.4 μmol/L,a direct bilirubin （DBil） value of 37.4 μmol/L,and an indirect bilirubin （IBil） value of 19.0 μmol/L.Amiodarone was withdrawn and protective liver therapy was given.On day 5 of amiodarone withdrawn,tests revealed the following values：ALT 965 U/L,AST 296 U/L,TBil 35.6 μmol/L,DBil 21.3 μmol/L,and IBil 14.3 μmol/L,and on day 15,ALT 37 U/L,AST 27 U/L,TBil 14.0 μmol/L,DBil 6.7 μmol/L,and IBil 7.3 μmol/L.