Mühlberg W, Becher K, Heppner H-J, Wicklein S, Sieber C
Institute for Biomedicine of Aging, University of Erlangen-Nürnberg, 2nd Department of Internal Medicine Klinikum Nürnberg, Heimerichstr. 58, 90419 Nürnberg, Germany.
Z Gerontol Geriatr. 2005 Jun;38(3):182-9. doi: 10.1007/s00391-005-0309-7.
Although morbidity and mortality of acute poisoning are increased in elderly compared to younger patients, little has been published on this topics in the last years (Medline search). To investigate the influence of age on the clinical course of acute poisoning with different toxic agents, a longitudinal retrospective study at the Toxicological Intensive Care Unit (ICU) of the 2nd Department of Internal Medicine (Klinikum Nürnberg, Germany) was performed.A total of 5883 patients treated at our toxicological ICU were enrolled into the study, including all patients of the years 1982, 1992, and 1997. These three years were selected to investigate possible time-dependent changes of intoxication characteristics and quality of therapy at our ICU over a time span of 15 years. For each patient the following data were obtained from a standardized toxicological record: age, gender, toxic agents responsible for acute poisoning, and length of stay at the toxicological ICU. For a subgroup of 3740 patients, the cause of acute poisoning and the clinical outcome was also recorded. As compared with younger patients, mean length of stay at the ICU, indicating a more serious course of acute poisoning, was prolonged in elderly and, i. e., in very old patients (p <0.001). However, this prolongation of time at the ICU was only observed in elderly patients poisoned with drugs or with mixed poisoning including drugs, while mean length of stay was not prolonged in elderly patients poisoned with alcohol, with illegal drugs, chemicals, animal/plant poison, or other toxic agents. Patients with the highest risk of dying in the ICU after acute poisoning were elderly patients attempting suicide with drugs. Mortality in 3740 patients with acute poisoning was 0.24%, while it was 2.17% in the 184 patients being 65 years old or older. Thus, mortality was 9-fold higher in the elderly. Mean length of stay at the ICU decreased significantly from 1982 to 1992 and to 1997 (p <0.001) indicating an improvement of the therapeutical ICU management of acute poisoning and/or less dangerous toxic agents (i. e. less barbiturates). The age-dependent increase of the length of stay at the ICU until very old age (> 80 years) was most pronounced in 1982 and also declined markedly until 1997.Age, suicide attempt, and ingestion of (multiple) drugs seem to be risk factors for a higher mortality and a prolonged stay in the ICU after acute poisoning. Although in general the clinical course after poisoning has more complications and an impaired prognosis in old age, each category of toxic agents (drugs, alcohol, chemicals, etc.) has its own special "risk profile" for elderly patients. However, due to advances in modern ICU medicine the general prognosis of acute poisoning is good in old and even in oldest old patients.
与年轻患者相比，老年人急性中毒的发病率和死亡率更高，但近年来关于该主题的文献报道较少（通过医学索引数据库检索）。为了研究年龄对不同毒物所致急性中毒临床过程的影响，我们在德国纽伦堡市立医院内科第二科室的毒理学重症监护病房进行了一项纵向回顾性研究。
共有5883名在我们毒理学重症监护病房接受治疗的患者纳入了本研究，包括1982年、1992年和1997年的所有患者。选择这三年是为了研究在15年的时间跨度内，我们重症监护病房中毒特征和治疗质量可能随时间发生的变化。从标准化的毒理学记录中获取了每位患者的以下数据：年龄、性别、导致急性中毒的毒物以及在毒理学重症监护病房的住院时间。对于3740名患者的亚组，还记录了急性中毒的原因和临床结局。与年轻患者相比，老年人（即非常年老的患者）在重症监护病房的平均住院时间延长，这表明急性中毒的病程更严重（p<0.001）。然而，这种在重症监护病房住院时间的延长仅在药物中毒或包括药物在内的混合中毒的老年患者中观察到，而酒精中毒、非法药物中毒、化学品中毒、动植物中毒或其他毒物中毒的老年患者平均住院时间并未延长。急性中毒后在重症监护病房死亡风险最高的患者是企图用药物自杀的老年患者。3740例急性中毒患者的死亡率为0.24%，而65岁及以上的184例患者的死亡率为2.17%。因此，老年人的死亡率高出9倍。从1982年到1992年再到1997年，重症监护病房的平均住院时间显著缩短（p<0.001），这表明急性中毒的重症监护治疗管理有所改善和/或毒物危险性降低（即巴比妥类药物减少）。在1982年，直至非常年老（>80岁）年龄组在重症监护病房住院时间随年龄增长的增加最为明显，到1997年也显著下降。
年龄、自杀企图以及（多种）药物摄入似乎是急性中毒后死亡率升高和在重症监护病房住院时间延长的危险因素。尽管一般来说，中毒后的临床过程在老年时并发症更多且预后较差，但每类毒物（药物、酒精、化学品等）对老年患者都有其特殊的“风险特征”。然而，由于现代重症监护医学的进展，急性中毒在老年甚至高龄老年患者中的总体预后良好。
