197例急诊药物中毒患者临床特征及治疗分析  

Analysis of clinical characteristics and treatm ent of 197 patients with emergency drug poisoning

作　　者：马帅[1] 张放[1] 杨悦 刘鑫[1] 赵海洋 梅雪[1] 郭树彬[1] Ma Shuai;Zhang Fang;Yang Yue;Liu Xin;Zhao Haiyang;Mei Xue;Guo Shubin(Department of Emergency Medicine,Beijing Chaoyang Hospital,Capital Medical University,Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院急诊科,北京心肺脑复苏重点实验室,100020

出　　处：《中华急诊医学杂志》2021年第3期265-271,共7页Chinese Journal of Emergency Medicine

摘　　要：目的分析急性药物中毒的临床特点,为急诊中毒患者的诊疗决策提供依据。方法回顾性收集北京朝阳医院急诊科2019年1月1日至2019年12月31日期间197例急性药物中毒患者临床资料(年龄、性别、基础疾病、服药时间、就诊时间、药物种类、药物毒检浓度、伴随症状、住院时长、治疗方式、液体复苏、患者转归及预后)。纳入标准:年龄≥14周岁,符合急诊急性中毒标准;排除标准:年龄<14周岁;临床资料不完整;农药中毒;急性有害气体中毒;其他非药物中毒患者。根据患者出院时转归分为存活组和死亡组,采用t检验、Mann-WhitneyU检验,分析临床特征、药物相关资料、实验室检查和治疗情况。结果纳入的急性药物中毒患者年龄为(38.9±20.4)岁,以青年患者居多,占比68.0%(134例),伴随症状以意识障碍106例、头晕56例、乏力38例、恶心呕吐42例常见。药物相关资料:就诊时间为7.17±0.89 h(0.5~96 h),服药种类分布以镇静安眠药105例(53.2%)、抗精神病药物73例(37.1%)、抗生素17例(8.6%)、解热镇痛药20例(10.2%)常见。临床资料分析:存活组患者入室GCS评分(12.47±3.05)高于死亡组(7.60±4.43),且两组间差异有统计学意义(P<0.01)。死亡组患者在谷丙转氨酶、尿素氮、肌酐、心肌肌钙蛋白I、凝血酶原时间、活化部分凝血活酶时间、血浆纤维蛋白原、D-二聚体均高于存活组,且差异有统计学意义。治疗与转归:治愈187例,死亡10例,接受洗胃治疗159例,血液净化治疗23例,对134例进行毒检患者治疗前后的毒物浓度进行比较发现,治疗后浓度均较前明显下降,其中艾司唑仑、佐匹克隆、西酞普兰、劳拉西泮、喹硫平差异均有统计学意义。结论急诊急性药物中毒以镇静安眠药、抗精神病药、解热镇痛药为主,临床上开展毒化实验室检查对指导患者治疗有指导意义,对于常见的急性药物中毒建立规范的监测系统和诊�Objective To analyze the clinical characteristics of acute drug poisoning,and provide better management for poisoned patients in Emergency Department.Methods We retrospectively enrolled 197 patients diagnosed as acute drug poisoning in Emergency Department of Beijing Chaoyang Hospital from January 1,2019 to December 31,2019.Medical records included age,gender,baseline diseases,medication time,visit time,kinds of drugs,drug concentrations,accompanying symptom,hospitalization duration,treatment,fluid resuscitation and outcomes.The inclusion criteria were as follows:age≥14 years old,and met the criteria of acute poisoning.The exclusion criteria were as follows:age<14 years old;incomplete clinical data;pesticide poisoning;toxic gas poisoning;and other non-drug poisoning.All patients were divided into the survival group and death group according to their outcomes at the discharge.Clinical characteristics,laboratory parameters and treatments were compared using the Student's test,Mann-Whitney U test,as appropriate.Results The mean age of all the patients was 38.9±20.4 years.The majority were young patients,accounting for 134 cases(68.0%).The accompanying symptoms included consciousness disturbance(106 cases),dizziness(56 cases),fatigue(38 cases),and nausea and/or vomiting(42 cases).The duration of medication-to-visit time was 0.5-96 h,with an average of 7.17±0.89 h.The types of drugs included 105(53.2%)sedatives and hypnotics,73 antipsychotics(37.1%),17 antibiotics(8.6%),and 20 antipyretic analgesics(10.2%).The Glasgow comascale(GCS)score of patients in the survival group was higher than that of the death group(12.47±3.05 vs 7.60±4.43,P<0.01).In the death group,the alanine aminotransferase,urea nitrogen,creatinine,cardiac troponin I,prothrombin time,activated partial thromboplastin time,plasma fibrinogen and D-dimer were higher than those of the survival group(all P<0.05).One hundred and eighty-seven patients were cured,while 10 patients died.One hundred and fifty-nine patients were treated with gastric lavage,an

关 键 词：急性药物中毒 临床特征 毒物浓度 

分 类 号：R595.4[医药卫生—内科学]