静脉用胺碘酮致急性严重肝损害七例分析

目的探讨短时（12h内）静脉滴注胺碘酮致急性严重肝功能损害的临床特点。方法收集我院2000年1月至2011年12月12h内静脉用胺碘酮患者908例的临床表现进行回顾性分析。结果908例患者中发生急性严重肝损害者7例，发生率为0．8％，病毒性肝炎指标均未见异常。静脉使用胺碘酮时间为1．0～10．0h，平均使用时间（6±4）h；胺碘酮使用总剂量为210～1150mg，平均（733±312）mg。静脉使用胺碘酮前有5例患者肝功能正常，2例轻度升高，A坍为15～78U／L，平均（39±21）U／L，AST为22～65U／L，平均（37±15）U／L。用胺碘酮后次日ALT为820～4845U／L，平均（2604±1295）U／L，AST为758～3962U／L，平均（2069±1091）U／L。肝功能恢复时间为7～15d，平均（10±3）d。肝功能恢复后继续随访至少3个月，未再出现肝损害。结论短时静脉滴注胺碘酮可导致急性严重肝损害，其发生较早，及时停用胺碘酮后可较快恢复。在静脉用胺碘酮过程中应监测肝功能，尽量避免或及时治疗肝损害。

Clinical analysis of seven cases of acute severe hepatic injury induced by intravenous infusion with amiodarone

Objective To analyze the clinical feature and possible mechanism of acute severe hepatic injury induced by intravenous infusion with amiodarone within 12 hours. Methods The clinical diagnoses, medication and characteristics of hepatic injury induced by intravenous infusion with amiodarone within 12 hours were analyzed in 908 cases from 2000 to 2011. Results There were 7 cases of acute severe hepatic injury in 908 cases of intravenous infusion with amiodarone（ the rate of 0.8% ）. The average time of intravenous infusion with amiodarone was （6 ±4）h. The average accumulated dosage of amiodarone was （733 ±312）mg, ranging from 210 mg to 1150 mg. The peak of alanine aminotransferase（ALT） was （2604 ± 1295 ）U/L, ranging from 820 U/L to 4845 U/L, and the aspartate aminotransferase （AST） was （2069 ±1091 ）U/L, ranging from 758 U/L to 3962 U/L. The liver enzyme levels returned to baseline values within （ 10 ± 3 ） d after hepatoprotection therapy, ranging from 7 d to 15 d. Conclusion Acute severe hepatic injury may be induced by intravenous infusion with amiodarone; the injury occurrs in prophase and the hepatic function can be recuperated after discontinuation of amiodarone.