University of Sydney, Sydney, NSW, Australia.
Calvary Mater Newcastle, Newcastle, NSW, Australia.
Med J Aust. 2015 May 4;202(8):438-42. doi: 10.5694/mja14.01116.
To examine inhospital mortality and morbidity associated with self-poisoning with different drug classes over an extended period.
DESIGN, SETTING AND PARTICIPANTS: A prospective cohort study over 26 years (1987-2012) with limited follow-up of patients presenting consecutively to a primary and tertiary referral toxicology centre covering Newcastle, Lake Macquarie and Port Stephens, Australia.
Hospital length of stay, types of drugs ingested, intensive care unit (ICU) admission, requirement for ventilation, inhospital deaths and rates of antidepressant drug use in Australia.
Over the study period, there were 17 266 admissions of patients poisoned by 34 342 substances (16 723 drugs available only on prescription). The median length of stay was 16 hours, 12.2% of patients (2101/17 266) were admitted to an ICU, 7.4% (1281/17 266) were ventilated and 78 (0.45%) died in hospital. Patient demographics, social and psychiatric factors remained stable over the 26-year period, but case fatality decreased (from 0.77% [15/1955] to 0.17% [7/4060]) as did ICU admissions (19.2% [376/1955] to 6.9% [280/4060]), ventilation (13.7% [268/1955] to 4.8% [193/4060]) and LOS. The most frequently ingested substances were alcohol, benzodiazepines, paracetamol, antidepressants and antipsychotics. There was a substantial fall in some highly toxic drugs (tricyclic antidepressants, barbiturates, conventional antipsychotics and theophylline), but increases in less toxic selective serotonin reuptake inhibitors, serotonin-noradrenaline reuptake inhibitors and paracetamol. A greater than sixfold increase in community antidepressant use was accompanied by only minor changes in overall and antidepressant self-poisoning rates.
Over two decades, there were decreases in poisonings by many highly toxic drugs which were associated with substantial reductions in morbidity and inhospital deaths. Despite massive increases in the number of antidepressant prescriptions, neither rates of self-harm nor the proportion of antidepressant poisonings increased markedly.
在较长时间内研究不同药物类别与自我中毒相关的住院死亡率和发病率。
设计、地点和参与者：这是一项前瞻性队列研究，时间跨度为 26 年（1987-2012 年），对连续就诊于澳大利亚纽卡斯尔、麦夸里湖和斯蒂芬斯港的一级和三级转诊毒理学中心的患者进行了有限的随访。
住院时间、摄入药物类型、重症监护病房（ICU）入院、通气需求、院内死亡和澳大利亚抗抑郁药使用情况。
在研究期间，有 17266 名患者因 34342 种物质（16723 种仅处方药）中毒入院。中位住院时间为 16 小时，12.2%（2101/17266）的患者入住 ICU，7.4%（1281/17266）需要通气，78 人（0.45%）在医院死亡。患者人口统计学、社会和精神因素在 26 年期间保持稳定，但病死率下降（从 0.77%[15/1955]降至 0.17%[7/4060]），ICU 入院率（从 19.2%[376/1955]降至 6.9%[280/4060]）、通气率（从 13.7%[268/1955]降至 4.8%[193/4060]）和 LOS 下降。最常摄入的物质是酒精、苯二氮䓬类、对乙酰氨基酚、抗抑郁药和抗精神病药。一些毒性很强的药物（三环类抗抑郁药、巴比妥类、传统抗精神病药和茶碱）的使用量大幅下降，但毒性较低的选择性 5-羟色胺再摄取抑制剂、5-羟色胺-去甲肾上腺素再摄取抑制剂和对乙酰氨基酚的使用量增加。社区抗抑郁药使用量增加了六倍多，但总体和抗抑郁药自我中毒率仅略有变化。
在 20 多年的时间里，许多毒性很强的药物的中毒率有所下降，这与发病率和住院死亡率的大幅下降有关。尽管抗抑郁药处方数量大幅增加，但自残率和抗抑郁药中毒率并未显著增加。
