Carrigan T D, Field H, Illingworth R N, Gaffney P, Hamer D W
Accident and Emergency Department, St James's University Hospital, Leeds.
J Accid Emerg Med. 2000 Jan;17(1):33-7. doi: 10.1136/emj.17.1.33.
To determine the prevalence and patterns of alcohol and drug use in patients with major trauma.
Consecutive trauma patient enrollment, 24 hours a day, was envisaged with anonymised patient data on gender, age band, and mechanism of injury collected. The study group had surplus plasma quantitatively analysed for ethanol concentration, and urine samples were initially screened, via immunoassay, for opiates, cannabinoids, amphetamines, benzodiazepines, cocaine, and methadone. Confirmation and specification of individual positive results was then performed using thin layer or gas-liquid chromatography. Drugs of treatment given in the resuscitation room, if subsequently detected in the urine samples, were excluded from the final results.
There were 116 eligible trauma patients assessed and treated in the resuscitation room over a six month period, of which 93 (80%) were enrolled. Altogether 27% of this trauma population had plasma ethanol concentrations greater than 80 mg/dl. There was a significantly higher prevalence of alcohol intoxication in the group not involved in a road traffic accident (RTA) compared with the group who were involved in a RTA. Initial screening of urine for drugs revealed a prevalence of 51%. After 12 exclusions due to iatrogenic administration of opiates, the final confirmed prevalence was 35% in this trauma population. The individual drug prevalence was 13% for cannabinoids, 11% for codeine, 8% for morphine, 6% for amphetamine, 6% for benzodiazepines, 3% for cocaine, 1% for dihydrocodeine, and 1% for methadone.
There is a notable prevalence of drug and alcohol use in this British accident and emergency trauma population. A significantly higher prevalence for alcohol intoxication was found in the non-RTA group compared with the RTA group. The patterns of drug usage detected reflect local influences and less cocaine use is seen compared with American studies. The association between alcohol, drugs, and trauma, together with ethically acceptable methods of screening, are discussed.
确定严重创伤患者酒精和药物使用的患病率及模式。
设想每天24小时连续纳入创伤患者，并收集患者性别、年龄组和损伤机制的匿名数据。对研究组的剩余血浆进行乙醇浓度定量分析，尿液样本首先通过免疫测定法筛查鸦片类药物、大麻素、苯丙胺、苯二氮䓬类、可卡因和美沙酮。然后使用薄层或气液色谱法对个体阳性结果进行确认和鉴定。复苏室给予的治疗药物，若随后在尿液样本中检测到，则从最终结果中排除。
在六个月期间，有116名符合条件的创伤患者在复苏室接受评估和治疗，其中93名（80%）被纳入研究。该创伤人群中共有27%的血浆乙醇浓度大于80mg/dl。与涉及道路交通事故（RTA）的组相比，未涉及RTA的组酒精中毒患病率显著更高。尿液药物初步筛查显示患病率为51%。由于医源性给予鸦片类药物而排除12例后，该创伤人群的最终确诊患病率为35%。个体药物患病率分别为：大麻素13%、可待因11%、吗啡8%、苯丙胺6%、苯二氮䓬类6%、可卡因3%、二氢可待因1%、美沙酮1%。
在这个英国的事故和急诊创伤人群中，药物和酒精使用的患病率显著。与RTA组相比，非RTA组酒精中毒患病率显著更高。检测到的药物使用模式反映了当地影响，与美国研究相比，可卡因使用较少。讨论了酒精、药物与创伤之间的关联以及符合伦理的筛查方法。
