Vance M V, Selden B S, Clark R F
Department of Medical Toxicology, Good Samaritan Regional Medical Center, Phoenix, Arizona.
Ann Emerg Med. 1992 Mar;21(3):243-6. doi: 10.1016/s0196-0644(05)80882-0.
Many factors influence the rate of gastric emptying and therefore the rate of drug absorption in the orally poisoned patient. Limited studies have evaluated the effect of body position on the rate of gastric emptying of radiographically marked foods and contrast media, but effects on drug absorption have not been studied previously. Our hypothesis was that body position would have an effect on the rate of drug absorption in an oral overdose model.
A blinded, within-subjects (crossover) design.
Six male and six female healthy, adult volunteer subjects with no concurrent drug use or medications affecting gastrointestinal function.
Five body positions commonly used in prehospital and emergency department settings were examined: left lateral decubitus, right lateral decubitus, supine, prone, and sitting. All were performed by all subjects in random order with a three-day washout phase between trials. To simulate an acute overdose, fasted subjects ingested 80 mg/kg acetaminophen in the form of 160-mg pediatric tablets. Each subject then remained in the body position for that trial for two hours. Acetaminophen levels were obtained at 15-minute intervals, and a two-hour area under the curve (AUC) was calculated for each subject trial to represent total drug absorption during each study period. Investigators were blinded to all results until all trials were completed.
All subjects completed the study. Group mean drug absorption as represented by two-hour AUC (mg.L.min) was calculated for each body position. AUC for left lateral decubitus (6,006 +/- 2,614) was lowest but did not significantly differ from that for supine (6,649 +/- 2,761). Both were significantly less than those for prone (7,432 +/- 1,809), right lateral decubitus (8,950 +/- 1,405), and sitting (8,608 +/- 1,725) positions (P less than .05 by one-way analysis of variance and follow-up paired t tests).
Initial drug absorption as determined by two-hour AUC was lowest in the left lateral decubitus position. Although the difference between the left lateral decubitus and supine positions did not reach statistical significance, both left lateral decubitus and supine were significantly lower than three other common patient body positions tested. Because the left lateral decubitus position has other advantages (eg, prevention of aspiration) in addition to minimizing drug absorption, we recommend that orally poisoned patients be placed in the left lateral decubitus position for prehospital and initial ED management.
许多因素会影响胃排空速率，进而影响口服中毒患者的药物吸收速率。有限的研究评估了体位对经放射显影标记的食物和造影剂胃排空速率的影响，但此前尚未研究其对药物吸收的影响。我们的假设是，在口服过量模型中，体位会对药物吸收速率产生影响。
一项盲法、受试者自身（交叉）设计。
12名健康的成年志愿者，其中6名男性和6名女性，近期未使用影响胃肠功能的药物或进行相关治疗。
研究了院前和急诊科常用的五种体位：左侧卧位、右侧卧位、仰卧位、俯卧位和坐位。所有受试者按随机顺序进行所有体位试验，每次试验之间有三天的洗脱期。为模拟急性过量服药，空腹受试者口服80mg/kg对乙酰氨基酚，剂型为160mg的儿童片剂。然后，每位受试者在该试验对应的体位保持两小时。每隔15分钟测量一次对乙酰氨基酚水平，并计算每位受试者每次试验的两小时曲线下面积（AUC），以代表每个研究期间的总药物吸收量。在所有试验完成之前，研究人员对所有结果均不知情。
所有受试者均完成研究。计算每个体位下以两小时AUC（mg·L·min）表示的组平均药物吸收量。左侧卧位的AUC（6,006±2,614）最低，但与仰卧位（6,649±2,761）相比无显著差异。二者均显著低于俯卧位（7,432±1,809）、右侧卧位（8,950±1,
