Liakoni Evangelia, Müller Sabine, Stoller Adrian, Ricklin Meret, Liechti Matthias E, Exadaktylos Aristomenis K
Department of Nephrology, Hypertension and Clinical Pharmacology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Emergency Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Scand J Trauma Resusc Emerg Med. 2017 Mar 7;25(1):26. doi: 10.1186/s13049-017-0369-x.
Although the recreational use of psychoactive substances is common there is only limited systematic collection of data on acute drug toxicity or hospital presentations. Currently, data from Switzerland are only available from the University Hospital of Basel. The present study aimed to describe the presentations due to recreational drug use at an emergency department in Bern, Switzerland during a 4 year period.
Retrospective analysis of cases presenting from May 2012 to April 2016 at the emergency department of the University Hospital of Bern, Switzerland, with symptoms/signs consistent with acute toxicity of recreational drug use. The cases were retrieved using a comprehensive full-text search algorithm of the electronic health records. Isolated ethanol intoxications were excluded.
During the study period, 503 of the 157,328 emergency department attendances were directly related to acute toxicity of substances used recreationally. The mean patient age was 33 years (range 16-74), 68% were male. Alcohol co-ingestion was reported in 54% of the cases, and use of more than one recreational drug in 37% of the cases. Most presentations were related to cocaine (29%), cannabis (26%), heroin (20%) and benzodiazepines/sedatives (18%). Urine drug screening immunoassay was available in 277 cases (55%). The most frequently detected substances were cannabis (29%), cocaine (22%), benzodiazepines (21%) and opioids excluding methadone (20%). There were only two intoxications with novel psychoactive substances (NPSs): One with methylone and one with 2,5-dimethoxy-4(n)-propylphenethylamine (2C-P). The majority of patients (58%) displayed impaired consciousness (Glasgow Coma Scale (GCS) <15) upon presentation and/or pre-hospital; 21% were unconscious (GCS <8). Other frequent symptoms were agitation (36%), tachycardia (29%), and anxiety (24%). Severe complications included two fatalities, three acute myocardial infarctions, two intracranial haemorrhages, as well as psychosis and seizures in 71 and 26 cases, respectively.
Most medical problems related to recreational drug use were associated with cocaine and cannabis use and were mainly characterised by central nervous system depression, sympathomimetic toxicity and/or psychiatric disorders. Presentations related to acute toxicities of NPSs appear to be uncommon, while prescription drugs were after classical recreational drugs the substances most commonly reported.
尽管精神活性物质的娱乐性使用很常见，但关于急性药物毒性或医院就诊情况的系统数据收集却很有限。目前，瑞士的数据仅来自巴塞尔大学医院。本研究旨在描述瑞士伯尔尼一家急诊科在4年期间因娱乐性药物使用而出现的就诊情况。
对2012年5月至2016年4月期间在瑞士伯尔尼大学医院急诊科就诊、症状/体征与娱乐性药物使用急性毒性相符的病例进行回顾性分析。通过电子健康记录的全面全文搜索算法检索病例。排除单纯乙醇中毒病例。
在研究期间，157328例急诊科就诊病例中有503例与娱乐性使用物质的急性毒性直接相关。患者平均年龄为33岁（范围16 - 74岁），68%为男性。54%的病例报告有酒精共同摄入，37%的病例使用了不止一种娱乐性药物。大多数就诊情况与可卡因（29%）、大麻（26%）、海洛因（20%）和苯二氮䓬类/镇静剂（18%）有关。277例（55%）进行了尿液药物筛查免疫测定。最常检测到的物质是大麻（29%）、可卡因（22%）、苯二氮䓬类（21%）和不包括美沙酮的阿片类药物（20%）。新型精神活性物质（NPS）中毒仅有两例：一例是甲酮中毒，一例是2,5 - 二甲氧基 - 4（n） - 丙基苯乙胺（2C - P）中毒。大多数患者（58%）就诊时和/或院前出现意识障碍（格拉斯哥昏迷量表（GCS）<15）；21%昏迷（GCS <8）。其他常见症状包括躁动（36%）、心动过速（29%）和焦虑（24%）。严重并发症包括两例死亡、三例急性心肌梗死、两例颅内出血，以及分别有71例和26例出现精神病和癫痫发作。
大多数与娱乐性药物使用相关的医疗问题与可卡因和大麻使用有关，主要表现为中枢神经系统抑制、拟交感神经毒性和/或精神障碍。与NPS急性毒性相关的就诊情况似乎不常见，而处方药是仅次于经典娱乐性药物之后最常报告的物质。
