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肝脏是药物代谢和解毒的重要脏器,肝功不全时药物代谢和解毒能力减退,药理作用和副作用增强。重症肝炎和肝硬化病人有时用常规量安眠药或镇静剂等就可诱发肝昏迷或使症状恶化,所以对肝功障碍病人用药应慎重。本文以肝功不全病人药物代谢的特殊性,叙述其用药量的决定法及存在问题。 一、肝功能不全的药物代谢及解毒能力 通常肝功能不全病人,由于肝血流量降低、血浆蛋白异常、肝细胞代谢能力减退和胆汁分泌阻碍等因素的影响,药物代谢及解毒能力减退。表1示肝功不全时,影响药物清除率的因素和受影响的药物。
Liver is an important organ for drug metabolism and detoxification, liver dysfunction, drug metabolism and detoxification decreased, pharmacological effects and side effects. Severe hepatitis and cirrhosis patients sometimes with conventional sleeping pills or sedatives and so can induce hepatic coma or worsen the symptoms, so medication for patients with liver dysfunction should be cautious. In this paper, patients with liver dysfunction, the particularity of drug metabolism, describes the determination of the dosage and the existence of problems. First, the liver dysfunction drug metabolism and detoxification Often patients with liver dysfunction, due to reduced liver blood flow, plasma protein abnormalities, decreased liver cell metabolism and bile secretion disorders and other factors, drug metabolism and detoxification abate. Table 1 shows the factors that affect drug clearance and affected drugs when liver failure occurs.