急诊医师如何早期识别及处理对乙酰氨基酚中毒

How Emergency Doctors Make an Early Diagnosis of Acetaminophen Overdose and Its Decision Making

对乙酰氨基酚（扑热息痛）广泛应用于临床,1971年美国首次发现其毒性作用。我国抗感冒的非处方药中使用对乙酰氨基酚的制剂很多,其中毒表现主要为肝损害。造成成人肝损害的剂量是150-250 mg/kg,〈10岁儿童似乎更耐受。对乙酰氨基酚过量的诊断需依据服药4 h后的血药浓度。对乙酰氨基酚中毒的急诊治疗原则是解毒、促进排泄,应用特异性解毒剂N-乙酰半胱氨酸（NAC）,还需谨记＂150＂法则：1〉150 mg/kg即为中毒剂量,如果无条件检测血药浓度,需行全疗程NAC治疗;2服毒后4 h如有条件测定血药浓度,若其〉150 mg/dl则需行全疗程、足量的NAC治疗。

Acetaminophen （ paracetamol） is widely used in clinical work. Its toxic effect was found in America in 1971, since then it is widely investigated in the world. There are lots of OTC patulin containing acetaminophen, which main toxic effect is the hepatic. Hepatic injury can happen as the dose is 150-250 mg/kg, and it seems that children younger than 10 years old have more tolerance. The diagnosis of acetaminophen overdose can be confirmed by the blood level test 4 hours after ingestion. Therapeutic principle includes enhanced elimination and antidotal use of N-acetylcysteine（ NAC） . The rule of 150 should be remembered：①〉150 mg/kg is the toxic level. If it is impossible for the blood test, full course of NAC treatment should begin as soon as possible. ②If it is possible to check the blood level, and if the blood level 4 hours after ingestion is over 150 mg/dl, full course of NAC should be performed.