Bjornaas M A, Hovda K E, Mikalsen H, Andrew E, Rudberg N, Ekeberg O, Jacobsen D
Department of Acute Medicine, Ullevaal University Hospital, Oslo, Norway.
Clin Toxicol (Phila). 2006;44(2):127-34. doi: 10.1080/15563650500514384.
The extent of drug abuse in patients admitted for self-poisonings is uncertain. The aim of this study was to assess the pattern of drugs of abuse among patients admitted for acute poisoning according to age and gender, and to study the concordance between the clinical assessments by the physicians on duty and the drug analyses.
Prospective cross sectional study of all patients (n = 405, 52% males, median age 31 years) treated for acute poisoning in our department during one year (2001). The physician on-call classified type of drug of abuse by history and clinical assessment. This was later compared to urine and blood samples analysed for ethanol, benzodiazepines, opiates, cocaine, ecstasy, GHB, amphetamine and cannabis.
In 320 admissions (79%), the comparison between clinical diagnosis and laboratory analyses could be performed. A total of 478 drugs were suspected and 621 were found. The main toxic agents found were benzodiazepines (49.7%), ethanol (40.3%), opiates (35.3%), cannabis (23.8%) and amphetamine (21.3%). Ninety-two had used drugs of abuse. The agreement between clinical assessments and laboratory findings was best for GHB and ethanol (kappa = 0.43), and for opiates (k = 0.38). For benzodiazepines and cannabis, the concordance was poor (k = 0.18 and 0.10, respectively). However, the correct clinical evaluation for these substances was 59% and 77%, respectively.
Drugs of abuse were more frequently found than suspected clinically. Benzodiazepines, ethanol and opiates were most common. The agreement between clinical assessment and drug analyses was moderate to low. Physicians seem to underestimate the use of these drugs.
因自我中毒入院患者的药物滥用程度尚不确定。本研究的目的是根据年龄和性别评估急性中毒入院患者的药物滥用模式，并研究值班医生的临床评估与药物分析之间的一致性。
对2001年在我科接受急性中毒治疗的所有患者（n = 405，52%为男性，中位年龄31岁）进行前瞻性横断面研究。值班医生通过病史和临床评估对药物滥用类型进行分类。随后将其与分析乙醇、苯二氮䓬类药物、阿片类药物、可卡因、摇头丸、γ-羟基丁酸、苯丙胺和大麻的尿液和血液样本进行比较。
在320例入院病例（79%）中，可以进行临床诊断与实验室分析之间的比较。共怀疑478种药物，发现621种。发现的主要有毒物质为苯二氮䓬类药物（49.7%）、乙醇（40.3%）、阿片类药物（35.3%）、大麻（23.8%）和苯丙胺（21.3%）。92人曾滥用药物。临床评估与实验室检查结果之间的一致性在γ-羟基丁酸和乙醇方面最佳（kappa = 0.43），在阿片类药物方面也较好（k = 0.38）。对于苯二氮䓬类药物和大麻，一致性较差（分别为k = 0.18和0.10）。然而，对这些物质的正确临床评估分别为59%和77%。
药物滥用的实际发现频率高于临床怀疑。苯二氮䓬类药物、乙醇和阿片类药物最为常见。临床评估与药物分析之间的一致性为中等至较低。医生似乎低估了这些药物的使用情况。
