现在位置是:首 页 >> 急诊学科 >> 中毒 >> 推荐文章
关键字:
推荐文章

    字体: | |

N-乙酰半胱氨酸(NAC)治疗对乙酰氨基酚中毒
原作者: Hong Kim,步涨 翻译,陈都,肖锋 文章来源: 《中华急诊医学杂志》编辑部 发布日期:2014-08-12

Title: NAC (N-acetylcysteine) for acetaminophen poisoning

题目:N-乙酰半胱氨酸(NAC)治疗对乙酰氨基酚中毒
Author 作者: Hong Kim
翻译:步涨 校对:陈都,肖锋


NAC is an effective antidote against acetaminophen (APAP) toxicity in preventing acute hepatotoxicity. It provides cysteine that is essential for glutathione synthesis and its availability is rate limiting.
NAC是一种有效的对乙酰氨基酚中毒拮抗剂,能预防其所导致的肝脏毒性。NAC能为谷胱甘肽合成提供必不少可为其合成过程中起限速作用的半胱氨酸。
Currently, PO and IV formulation is available in the U.S. Regardless of the route, NAC is equally effective in preventing APAP induced acute hepatotoxicity when administered within 8 hours after single acute ingestion. 1
口服和静脉使用的NAC剂型目前已在美国上市。不管使用哪种剂型的NAC,在给药八小时内都能对APAP诱导的肝毒性有等效的预防效果。
Adverse effects of NAC
NAC的不良反应
1.Anaphylactoid reaction 类过敏反应:
a.     More frequently reported with IV administration and during the first regimen of NAC (150 mg/kg over 60 min) administration. (dose and rate dependent)
更多的见于NAC的首剂静脉给药(150mg/kg 超过60min,剂量及速率依赖型)
b.     Higher risk of anaphylactoid reaction in patients with negative APAP vs. patients with elevated APAP level.
APAP阴性的患者相比APAP水平升高的患者过敏反应风险更大。
c.      Management: Benadryl as needed and slow infusion rate.
处理:根据需要给苯海拉明,减慢输液速度。
2.Hyponatremia in children if inappropriate volume of diluent (D5W) used. Dose calculator: http://acetadote.com/dosecalc.php
如果稀释液的用量不恰当,儿童易发生低钠血症。
剂量计算器:http://acetadote.com/dosecalc.php
3.     Laboratory: increase Prothrombin time (PT).
实验室检查:凝血酶原时间(PT)延长。
4.     Fatality from iatrogenic NAC overdose has been reported.
 也有医源性NAC过量使用致死的报道。
Advantage of IV NAC 静脉NAC给药的优点:
1.     Convenience 方便
2.     100% bioavailability 100%的生物利用度
3.     Shorter hospital length of stay 住院时间更短
4.     Minimum GI symptoms (nausea & vomiting) compared to PO route
 相对口服给药,上消化道症状(如恶心呕吐)更小。
Indication of IV NAC 静脉给予NAC的适应症:
1.     Severe hepatotoxicity or fulminant liver failure
严重的肝脏毒性或爆发性肝功能衰竭
2.     APAP poisoning during pregnancy
孕期APAP中毒
3.     Unable to tolerate PO intake (nausea, vomiting, altered mental status)
不能口服给药(恶心呕吐,神智不清)
However many clinicians administer IV NAC for their advantages over PO NAC.
因而相比于口服给药,更多临床医师愿意使用优点更多的静脉NAC。
 Take home message:
要点:
1.PO and IV NAC are equally effective when administered within 8 hours after single acute ingestion.
口服和静脉注射的NAC在急性中毒八小时内的效果是相等的。
2.     Anaphylactoid reaction is frequently encountered AE during the infusion of 1st NAC regimen and patients with negative/low APAP level may be at higher risk.
过敏反应多见于首次使用静脉NAC的患者,且阴性/低水平APAP的患者发生过敏反应的风险更高。
3.     No emergent need to start NAC in presumed acetaminophen overdose patients prior to obtaining APAP level.
在怀疑过量使用乙酰氨基酚的患者获知其APAP水平前,并没有非常迫切开始使用NAC 的需要。
References 参考文献:
•Prescott L. Oral or intravenous N-Acetylcysteine for acetaminophen poisoning? Ann Emerg Med 2005;45:409-413.
•Schmidt LE. Identification of patients at risk of anaphylactoid reactions to N-acetylcysteine in the treatment of paracetamol overdose. Clin Toxicol 2013;51:467-472.
Jang DH et al. In vitro study of N-acetylcysteine on coagulation factors in plasma samples from healthy subjects. J med Toxicol 2012;9:49-53.

文章来源:《中华急诊医学杂志》编辑部