Comparison of the 20-Hour Intravenous and 72-Hour Oral Acetylcysteine Protocols for the Treatment of Acute Acetaminophen Poisoning
Comparison of the 20-Hour Intravenous and 72-Hour Oral Acetylcysteine Protocols for the Treatment of Acute Acetaminophen Poisoning
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DOI：
10.1016/j.annemergmed.2009.05.010
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发表时间：
2009-10-01
影响因子：
6.2
通讯作者：
Rumack, Barry H.
中科院分区：
文献类型：
--
作者：
Yarema, Mark C.;Johnson, David W.;Rumack, Barry H.
研究目的：比较两组接受 20 小时静脉注射或 72 小时口服乙酰半胱氨酸方案治疗的患者急性对乙酰氨基酚中毒后的结果。方法：我们进行了一项回顾性队列研究，采用历史对照，比较接受 2 种乙酰半胱氨酸方案之一治疗的患者。 20 小时组的数据来自对 1980 年至 2005 年在加拿大医院开始接受 20 小时静脉注射方案的患者的病历审查。72 小时组由 1976 年至 1985 年在美国医院接受 72 小时口服方案治疗的患者历史队列组成。主要结局是肝毒性（转氨酶水平 >1,000 IU/L）。分析的 4,048 名患者中，2,086 名患者属于 20 小时组，1,962 名患者属于 72 小时组。 20小时组的肝毒性发生率为13.9%，72小时组为15.8%（绝对差异-1.9%；95%置信区间[CI]-4.2至0.3）。当乙酰半胱氨酸在摄入后 12 小时内开始服用时，20 小时组的肝毒性相对风险较低。当乙酰半胱氨酸在摄入后 18 小时后开始服用时，72 小时组的相对风险较低。当摄入乙酰半胱氨酸后 12 至 18 小时开始治疗时，各组之间没有显着的风险差异。 20 小时组中有 1 名患者接受了肝移植，并因对乙酰氨基酚毒性死亡，而 72 小时组则有 3 名患者死亡，而没有接受肝移植。 2,086 名患者中，有 148 名报告了静脉注射乙酰半胱氨酸的过敏样反应（7.1%；95% CI 6.1% 至 8.3%）。这项研究受到来自不同国家和研究年份的 2 个独立数据集的比较的限制。结论：根据乙酰半胱氨酸起始时间的不同，20 小时和 72 小时方案之间的肝毒性风险有所不同。它赞成对早期就诊的患者采用 20 小时方案，而对急性对乙酰氨基酚过量后就诊较晚的患者则赞成采用 72 小时方案。 [安紧急医学。 2009；54：606-614。]
Study objective: To compare outcomes after acute acetaminophen poisoning in 2 large cohorts of patients treated with either the 20-hour intravenous or 72-hour oral acetylcysteine protocol.Methods: We conducted a retrospective cohort study with historical control comparing patients treated with one of 2 acetylcysteine regimens. Data for the 20-hour group were obtained from a medical record review of patients on whom the 20-hour intravenous protocol was initiated in Canadian hospitals from 1980 to 2005. The 72-hour group consisted of a historical cohort of patients treated in US hospitals with the 72-hour oral protocol from 1976 to 1985. The primary outcome was hepatotoxicity (aminotransferase levels >1,000 IU/L).Results: Of the 4,048 patients analyzed, 2,086 were in the 20-hour group and 1,962 were in the 72-hour group. The incidence of hepatotoxicity was 13.9% in the 20-hour group and 15.8% in the 72-hour group (-1.9% absolute difference; 95% confidence interval [CI] -4.2 to 0.3). The relative risk of hepatotoxicity was lower in the 20-hour group when acetylcysteine was initiated within 12 hours of ingestion. The relative risk was lower in the 72-hour group when acetylcysteine was initiated later than 18 hours after ingestion. There was no significant risk difference between groups when acetylcysteine treatment was started 12 to 18 hours after ingestion. One patient in the 20-hour group received a liver transplant and died because of acetaminophen toxicity compared with no liver transplants and 3 deaths in the 72-hour group. Anaphylactoid reactions to intravenous acetylcysteine were reported in 148 of 2,086 patients (7.1%; 95% CI 6.1% to 8.3%). This study is limited by comparison of 2 separate data sets from different countries and study years.Conclusion: The risk of hepatotoxicity differed between the 20-hour and 72-hour protocols according to the time to initiation of acetylcysteine. It favored the 20-hour protocol for patients presenting early and favored the 72-hour protocol for patients presenting late after acute acetanninophen overdose. [Ann Emerg Med. 2009;54:606-614.]