对乙酰氨基酚是最常见的蓄意滥用药物之一。[1]Gunnell D, Murray V, Hawton K. Use of paracetamol (acetaminophen) for suicide and nonfatal poisoning: worldwide patterns of use and misuse. Suicide Life Threat Behav. 2000 Winter;30(4):313-26.http://www.ncbi.nlm.nih.gov/pubmed/11210057?tool=bestpractice.com 在英国,对乙酰氨基酚是最常见的过量使用药物,占医院收治中毒患者的 48%,且每年导致约 100-200 人死亡。[2]Hawkins LC, Edwards JN, Dargan PI. Impact of restricting paracetamol pack sizes on paracetamol poisoning in the United Kingdom: a review of the literature. Drug Saf. 2007;30(6):465-79.http://www.ncbi.nlm.nih.gov/pubmed/17536874?tool=bestpractice.com 然而,随着自我伤害行为的减少,对乙酰氨基酚中毒发病率也相应下降。[3]Morgan OW, Griffiths C, Majeed A. Interrupted time-series analysis of regulations to reduce paracetamol (acetaminophen) poisoning. PLoS Med. 2007 Apr;4(4):e105.https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0040105http://www.ncbi.nlm.nih.gov/pubmed/17407385?tool=bestpractice.com[4]Sheen CL, Dillon JF, Bateman DN, et al. Paracetamol-related deaths in Scotland, 1994-2000. Br J Clin Pharmacol. 2002 Oct;54(4):430-2.https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2125.2002.t01-1-01671.xhttp://www.ncbi.nlm.nih.gov/pubmed/12392592?tool=bestpractice.com
美国每周约 5000 万人使用对乙酰氨基酚或含有对乙酰氨基酚成份的药物。[5]Kaufman DW, Kelly JP, Rosenberg L, et al. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. JAMA. 2002 Jan 16;287(3):337-44.https://jamanetwork.com/journals/jama/fullarticle/194572http://www.ncbi.nlm.nih.gov/pubmed/11790213?tool=bestpractice.com 中毒可发生于因疼痛而自我服药的过程中或在蓄意过量服药之后;对乙酰氨基酚是最常见的蓄意过量服用的药物之一,尤其是在年轻人当中。[1]Gunnell D, Murray V, Hawton K. Use of paracetamol (acetaminophen) for suicide and nonfatal poisoning: worldwide patterns of use and misuse. Suicide Life Threat Behav. 2000 Winter;30(4):313-26.http://www.ncbi.nlm.nih.gov/pubmed/11210057?tool=bestpractice.com[6]Hawton K, Harriss L. Deliberate self-harm in young people: characteristics and subsequent mortality in a 20-year cohort of patients presenting to hospital. J Clin Psychiatry. 2007 Oct;68(10):1574-83.http://www.ncbi.nlm.nih.gov/pubmed/17960975?tool=bestpractice.com
在 2016 年,美国毒物控制中心协会国家毒物数据系统 (American Association of Poison Control Centers' National Poison Data System) 报告了 49,417 例单独对乙酰氨基酚(680 例危及生命或致残性;82 例致死性)暴露病例(指有实际或疑似毒物接触 [即,摄入、吸入、吸收])和 21,676 例涉及对乙酰氨基酚和另一种药物联合用药的病例(446 例危及生命或致残性;42 例致死性)。[7]Gummin DD, Mowry JB, Spyker DA, et al. 2016 annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 34th annual report. Clin Toxicol (Phila). 2017 Dec;55(10):1072-1252.https://www.tandfonline.com/doi/abs/10.1080/15563650.2017.1388087http://www.ncbi.nlm.nih.gov/pubmed/29185815?tool=bestpractice.com
临床上,急诊患者过量使用非处方镇痛药的比例很高,其中牙痛作为危险因素尤其明显。[8]Daly FF, O'Malley GF, Heard K, et al. Prospective evaluation of repeated supratherapeutic acetaminophen (paracetamol) ingestion. Ann Emerg Med. 2004 Oct;44(4):393-8.http://www.ncbi.nlm.nih.gov/pubmed/15459622?tool=bestpractice.com[9]Heard K, Sloss D, Weber S, et al. Overuse of over-the-counter analgesics by emergency department patients. Ann Emerg Med. 2006 Sep;48(3):315-8.http://www.ncbi.nlm.nih.gov/pubmed/16934651?tool=bestpractice.com[10]Vogel J, Heard KJ, Carlson C, et al. Dental pain as a risk factor for accidental acetaminophen overdose: a case-control study. Am J Emerg Med. 2011 Nov;29(9):1125-9.http://www.ncbi.nlm.nih.gov/pubmed/20951526?tool=bestpractice.com 许多品牌药物含有不同剂量的对乙酰氨基酚,可导致意外过量。
在成人和儿科患者中,很少有在静脉注射对乙酰氨基酚后导致医源性对乙酰氨基酚中毒的病例。[11]Berling I, Anscombe M, Isbister GK. Intravenous paracetamol toxicity in a malnourished child. Clin Toxicol (Phila). 2012 Jan;50(1):74-6.http://www.ncbi.nlm.nih.gov/pubmed/22115056?tool=bestpractice.com[12]Beringer RM, Thompson JP, Parry S, et al. Intravenous paracetamol overdose: two case reports and a change to national treatment guidelines. Arch Dis Child. 2011 Mar;96(3):307-8.http://www.ncbi.nlm.nih.gov/pubmed/21127004?tool=bestpractice.com