对乙酰氨基酚中毒治疗的范式转变:从长疗程到短程快速N-乙酰半胱氨酸方案的循证进展

摘要/Abstract

摘要： 对乙酰氨基酚过量是导致药物性肝损伤及急性肝衰竭的主要原因之一,N-乙酰半胱氨酸(NAC)是其特效解毒剂。传统的“三袋法”静脉方案(300 mg/kg,耗时20~21 h)虽疗效明确,但存在不良反应多、疗程长等问题。近年来,以SNAP方案和SARPO方案为代表的“两袋法”短程方案,通过随机对照试验、大型队列研究及临床实践证实,其在预防肝毒性方面具有非劣效性,并在降低过敏反应与胃肠道不良反应方面表现更优。这些方案通过简化给药流程、缩短住院时间,实现了安全性、有效性与医疗效率的同步提升。本文系统梳理对乙酰氨基酚的肝毒性机制与NAC的作用原理,基于最新循证证据,重点阐述NAC治疗方案从传统“三袋法”向现代“两袋法”及个体化短程方案的演变历程,分析当前临床实践中的挑战,并展望基于精准风险分层的未来治疗方向。

关键词: 对乙酰氨基酚, N-乙酰半胱氨酸, 药物性肝损伤, 急性肝衰竭, 短疗程方案, 荟萃分析, 研究进展

黄德良, 朱质斌, 陈军. 对乙酰氨基酚中毒治疗的范式转变:从长疗程到短程快速N-乙酰半胱氨酸方案的循证进展[J]. 肝脏, 2026, 31(1): 5-7.

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