Zakharov Sergey, Nurieva Olga, Kotikova Katerina, Belacek Jaromir, Navratil Tomas, Pelclova Daniela
Toxicological Information Centre, General University Hospital in Prague, Na Bojisti 1, 120 00 Prague 2, Czech Republic.
First Faculty of Medicine, Department of Occupational Medicine, Charles University in Prague, Na Bojisti 1, 120 00 Prague 2, Czech Republic.
Monatsh Chem. 2017;148(3):409-419. doi: 10.1007/s00706-016-1846-z. Epub 2016 Oct 25.
Mass methanol poisonings present a serious problem for health systems worldwide, with poor outcome associated with delayed treatment. Positive pre-hospital serum ethanol concentration may have predictive value as the prognostic factor of the treatment outcome. We studied the effect of positive serum ethanol level on admission to hospital on survival in patients treated during the Czech methanol outbreak during 2012-2014. Cross-sectional cohort study was performed in 100 hospitalized patients with confirmed methanol poisoning. Pre-hospital ethanol was administered in 42 patients (by paramedic/medical staff to 30 patients and self-administered by 12 patients before admission); 58 patients did not receive pre-hospital ethanol. Forty-two patients had detectable serum ethanol concentration on admission to hospital [median 18.3 (IQR 6.6-32.2) mmol dm]. Pre-hospital ethanol administration by paramedic/medical staff had a significant effect on survival without visual and CNS sequelae when adjusted for arterial blood pH on admission (OR 8.73; 95 % CI 3.57-21.34; < 0.001). No patients receiving pre-hospital ethanol died compared with 21 not receiving ( < 0.001). Positive serum ethanol concentration on admission to hospital was a predictor for survival without health sequelae when adjusted for arterial blood pH (OR 8.10; 95 % CI 2.85-23.02; < 0.001). The probability of visual and CNS sequelae in survivors reduced with increasing serum ethanol concentration on admission.
大规模甲醇中毒对全球卫生系统而言是一个严重问题，治疗延迟会导致不良后果。院前血清乙醇浓度呈阳性可能具有预测价值，可作为治疗结果的预后因素。我们研究了2012 - 2014年捷克甲醇中毒事件期间，入院时血清乙醇水平呈阳性对接受治疗患者生存情况的影响。对100例确诊为甲醇中毒的住院患者进行了横断面队列研究。42例患者院前使用了乙醇（30例由护理人员/医务人员给药，12例在入院前自行给药）；58例患者未接受院前乙醇治疗。42例患者入院时血清乙醇浓度可检测到[中位数18.3（四分位间距6.6 - 32.2）mmol/dm³]。在校正入院时动脉血pH值后，护理人员/医务人员进行的院前乙醇给药对无视觉和中枢神经系统后遗症的生存情况有显著影响（比值比8.73；95%置信区间3.57 - 21.34；P<0.001）。接受院前乙醇治疗的患者无死亡病例，而未接受治疗的有21例死亡（P<0.001）。在校正动脉血pH值后，入院时血清乙醇浓度呈阳性是无健康后遗症生存情况的一个预测指标（比值比8.10；95%置信区间2.85 - 23.02；P<0.001）。幸存者出现视觉和中枢神经系统后遗症的概率随着入院时血清乙醇浓度的升高而降低。
