Vale J A
Department of Medicine, Dudley Road Hospital, Birmingham.
Ther Umsch. 1992 Feb;49(2):102-6.
Procedures to reduce the absorption of ingested poisons have been employed widely for decades in the management of intoxicated patients. However, evidence of substantial clinical benefit to the majority of patients undergoing such treatments is lacking. Volunteer studies suggest that activated charcoal is generally more effective than either syrup of ipecacuanha or gastric lavage, though lavage may be more effective than syrup of ipecacuanha. Studies in poisoned patients have shown that although lavage is more effective than syrup of ipecacuanha, it led to a better outcome in comatose patients only if performed less than one hour after overdose. Syrup of ipecacuanha did not alter the outcome beneficially in those who were alert on presentation and is known to produce significantly more complications than charcoal alone even in patients who are awake with a gag reflex. A recent study suggests that activated charcoal may be superior both to lavage and syrup of ipecacuanha. Based on these studies it would seem reasonable to recommend that 50 to 100 g activated charcoal be administered to patients who have taken a substantial amount of a toxic substance less than one hour previously. This may be done conveniently by using an orogastric tube, which would also allow lavage to be undertaken with possible additional benefit.
几十年来，减少摄入毒物吸收的方法在中毒患者的治疗中得到了广泛应用。然而，缺乏证据表明对大多数接受此类治疗的患者有实质性的临床益处。志愿者研究表明，活性炭通常比吐根糖浆或洗胃更有效，不过洗胃可能比吐根糖浆更有效。对中毒患者的研究表明，虽然洗胃比吐根糖浆更有效，但只有在过量服药后不到一小时进行洗胃，昏迷患者的预后才会更好。吐根糖浆对就诊时清醒的患者并无有益的预后改善作用，而且已知即使在有吞咽反射的清醒患者中，吐根糖浆产生的并发症也比单独使用活性炭多得多。最近一项研究表明，活性炭可能比洗胃和吐根糖浆都更具优势。基于这些研究，对于在不到一小时前摄入大量有毒物质的患者，建议给予50至100克活性炭似乎是合理的。这可以通过使用鼻胃管方便地完成，鼻胃管还可用于洗胃，可能会带来额外的益处。
