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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 female patient underwent hysteromyoma and uterine artery embolization due to cervical pregnancy and vaginal bleeding. Preoperative physical examination showed normal liver function. Due to postoperative pain, the patient orally took 20 tablets of paracetamol dihydrocodeine within 20 hours. On the second day after taking the medicine, alanine aminotransferase (ALT) of 263 U / L and aspartate aminotransferase (AST) of 226 U / L were given to the laboratory and oral administration of glucurolactone 100 mg 3 times / d. On the third day, the patient v. Nausea, vomiting, eating less. The fourth day laboratory tests showed ALT1128U / L, AST1 006U / L, total bilirubin 44.7μmol / L. Diagnosed as paracetamol due to severe liver damage caused by codeine, polyene phosphate choline 930 mg into 5% glucose injection 100 ml, compound glycyrrhizin injection 80 ml + sodium chloride injection 250 ml, also Prototype glutathione 1.8 g into 5% glucose injection 100 ml, 1 / d intravenous infusion. Hepatic treatment on the 9th day, the patient returned to normal diet, nausea, vomiting and other symptoms disappeared, laboratory tests showed ALT 404 U / L, AST 32 U / L; on the 21st day ALT 34 U / L, AST 18 U / L.