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1例22岁女性患者因间断性发热自行不规律口服尼美舒利100 mg/次及布洛芬400 mg/次(给药次数不详),共计27 d。服药第23天患者出现皮肤、巩膜明显黄染,尿液呈豆油色。4 d后入院,体格检查发现上腹部压痛,剑突下3 cm可触及肝脏。实验室检查:外周血白细胞计数12.3×10~9/L,凝血酶原时间22 s,凝血酶原活动度34%,纤维蛋白原1.63 g/L,丙氨酸转氨酶407 U/L,天冬氨酸转氨酶558 U/L,总胆红素179.7μmol/L,直接胆红素165.0μmol/L,氨101μmol/L。考虑为尼美舒利和布洛芬引起的肝衰竭。给予患者抗感染、保肝、褪黄和降氨药物治疗,间断输注新鲜冰冻血浆并行血浆置换等。入院后第25天患者肝功能基本恢复正常。
A 22-year-old female patient received irregular nimesulide 100 mg / d and ibuprofen 400 mg / d (the number of dosing was unknown) due to intermittent fever for a total of 27 days. On the 23rd day after taking the medicine, the skin of the patient appeared, and the sclera was obviously yellowed and the urine was in soybean oil color. 4 d after admission, physical examination found upper abdominal tenderness, 3 cm under the xiphoid can reach the liver. Laboratory tests: peripheral blood leukocyte count 12.3 × 10 ~ 9 / L, prothrombin time 22 s, prothrombin activity 34%, fibrinogen 1.63 g / L, alanine aminotransferase 407 U / L, aspartate 558 U / L of ALT, 179.7 μmol / L of total bilirubin, 165.0 μmol / L of direct bilirubin and 101 μmol / L of ammonia. Consider the liver failure caused by nimesulide and ibuprofen. Give patients anti-infective, liver protection, yellowing and ammonia drug treatment, intermittent infusion of fresh frozen plasma parallel plasma exchange. On the 25th day after admission, the liver function returned to normal.