γ-羟基丁酸及其相关类似物中毒：临床特征以及单纯中毒与合并其他滥用物质中毒的比较

Intoxication by gamma hydroxybutyrate and related analogues: Clinical characteristics and comparison between pure intoxication and that combined with other substances of abuse.

作者信息

Miró Òscar, Galicia Miguel, Dargan Paul, Dines Alison M, Giraudon Isabelle, Heyerdahl Fridtjof, Hovda Knut E, Yates Christopher, Wood David M, Liakoni Evangelia, Liechti Matthias, Jürgens Gesche, Pedersen Carsten Boe, O'Connor Niall, Markey Gerard, Moughty Adrian, Lee Christopher, O'Donohoe Patrick, Sein Anand Jacek, Puiguriguer Jordi, Homar Catalina, Eyer Florian, Vallersnes Odd Martin, Persett Per Sverre, Chevillard Lucie, Mégarbane Bruno, Paasma Raido, Waring W Stephen, Põld Kristiina, Rabe Christian, Kabata Piotr Maciej

机构信息

Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain.

出版信息

Toxicol Lett. 2017 Aug 5;277:84-91. doi: 10.1016/j.toxlet.2017.05.030. Epub 2017 Jun 1.

DOI:10.1016/j.toxlet.2017.05.030

PMID:28579487

Abstract

OBJECTIVE

To study the profile of European gamma-hydroxybutyrate (GHB) and gammabutyrolactone (GBL) intoxication and analyse the differences in the clinical manifestations produced by intoxication by GHB/GBL alone and in combination with other substances of abuse.

METHOD

We prospectively collected data on all the patients attended in the Emergency Departments (ED) of the centres participating in the Euro-DEN network over 12 months (October 2013 to September 2014) with a primary presenting complaint of drug intoxication (excluding ethanol alone) and registered the epidemiological and clinical data and outcomes.

RESULTS

We included 710 cases (83% males, mean age 31 years), representing 12.6% of the total cases attended for drug intoxication. Of these, 73.5% arrived at the ED by ambulance, predominantly during weekend, and 71.7% consumed GHB/GBL in combination with other substances of abuse, the most frequent additional agents being ethanol (50%), amphetamine derivatives (36%), cocaine (12%) and cannabis (8%). Among 15 clinical features pre-defined in the project database, the 3 most frequently identified were altered behaviour (39%), reduced consciousness (34%) and anxiety (14%). The severity ranged from mild cases requiring no treatment (308 cases, 43.4%) to severe cases requiring admission to intensive care (103 cases, 14.6%) and mechanical ventilation (49 cases, 6.9%). No deaths were reported. In comparison with only GHB/GBL consumption, patients consuming GHB/GBL with co-intoxicants presented more vomiting (15% vs. 3%, p<0.001) and cardiovascular symptoms (5.3% vs. 1.5%, p<0.05), a greater need for treatment (59.8% vs. 48.3%, p<0.01) and a longer ED stay (11.3% vs. 3.6% patients with ED stay >12h, p<0.01).

CONCLUSIONS

The profile of the typical GHB/GBL-intoxicated European is a young male, requiring care for altered behaviour and reduced level of consciousness, mainly during the weekend. The clinical features are more severe when GHB is consumed in combination with other substances of abuse.

摘要

目的

研究欧洲γ-羟基丁酸（GHB）和γ-丁内酯（GBL）中毒的概况，并分析单独使用GHB/GBL中毒以及与其他滥用物质联合中毒所产生的临床表现差异。

方法

我们前瞻性收集了参与欧洲药物急诊网络（Euro-DEN）的各中心急诊科在12个月（2013年10月至2014年9月）内所有以药物中毒为主诉（不包括单纯乙醇中毒）的患者的数据，并记录了流行病学、临床数据及转归情况。

结果

我们纳入了710例患者（83%为男性，平均年龄31岁），占药物中毒就诊总病例数的12.6%。其中，73.5%的患者通过救护车送至急诊科，主要在周末，71.7%的患者同时使用了GHB/GBL和其他滥用物质，最常见的其他物质是乙醇（50%）、苯丙胺衍生物（36%）、可卡因（12%）和大麻（8%）。在项目数据库预先定义的15项临床特征中，最常出现的3项是行为改变（39%）、意识减退（34%）和焦虑（14%）。严重程度从无需治疗的轻症病例（308例，43.4%）到需要入住重症监护病房的重症病例（103例，14.6%）以及需要机械通气的病例（49例，6.9%）不等。未报告死亡病例。与仅使用GHB/GBL的患者相比，同时使用GHB/GBL和其他中毒物质的患者呕吐更多（15%对3%，p<0.001）、心血管症状更多（5.3%对1.5%，p<0.05）、更需要治疗（59.8%对48.3%，p<0.01）且在急诊科停留时间更长（急诊科停留时间>的患者中11.3%对3.6%，p<0.01）。