Good Alison M, Kelly Catherine A, Bateman D Nicholas
National Poisons Information Service (Edinburgh), Scottish Poisons Information Bureau, Royal Infirmary, Edinburgh, UK.
Clin Toxicol (Phila). 2007;45(3):234-9. doi: 10.1080/15563650601031601.
To investigate how poisons centres advise on management of common drug poisonings and compare advice on gut decontamination with the EAPCCT/AACT Position Statements.
An interactive questionnaire was sent to 14 poisons centres asking about working practices, "top 20" enquiries in 2002, and management of 4 specific drug poisonings.
Replies were received from centres in 11 countries. Annual telephone enquiry numbers varied from 620 (Sri Lanka) to over 50,000 (Germany for 2000). Recommendations for gut decontamination for acetaminophen poisoning were: activated charcoal (AC) alone (5 centres); gastric lavage (GL) alone (1); AC and/or GL (3); AC, GL and/or ipecac (2). Only 40% (4/10) recommended AC and 50% (3/6) GL within 1 hour. Intervention doses for gut decontamination ranged from 100-200 mg/kg (nine centres) and for "high-risk" groups 75-100 mg/kg (3). Plasma concentration for N-acetylcysteine (NAC) treatment ranged from 150 mg/L (four centres) to 200 mg/L (6) at 4 hours. Results were similarly varied for three other common drug poisons (benzodiazepines, amitriptyline, and paroxetine).
Most poisons centres have protocols that differ in terms of gut decontamination, timing, and intervention doses. Many centres recommend charcoal or gastric lavage after the 1-hour limit proposed in the Position Statements. There is scope for rationalization of approaches to the management of common poisons.
调查毒物中心如何就常见药物中毒的处理提供建议，并将胃肠道去污的建议与欧洲毒物控制中心和临床毒理学家协会/美国临床毒理学会的立场声明进行比较。
向14个毒物中心发送了一份交互式问卷，询问其工作方法、2002年的“前20”咨询问题以及4种特定药物中毒的处理。
收到了来自11个国家的中心的回复。年度电话咨询数量从620（斯里兰卡）到超过50000（德国2000年的数据）不等。对乙酰氨基酚中毒的胃肠道去污建议如下：仅用活性炭（AC）（5个中心）；仅用洗胃（GL）（1个）；AC和/或GL（3个）；AC、GL和/或吐根糖浆（2个）。只有40%（4/10）的中心建议在1小时内使用AC，50%（3/6）的中心建议使用GL。胃肠道去污的干预剂量为100 - 200 mg/kg（9个中心），“高危”组为75 - 100 mg/kg（3个）。4小时时N - 乙酰半胱氨酸（NAC）治疗的血浆浓度范围为150 mg/L（4个中心）至200 mg/L（6个）。其他三种常见药物中毒（苯二氮卓类、阿米替林和帕罗西汀）的结果同样存在差异。
大多数毒物中心的方案在胃肠道去污、时间和干预剂量方面存在差异。许多中心在立场声明建议的1小时时限之后推荐使用活性炭或洗胃。常见毒物处理方法的合理化仍有空间。
