Cordovilla-Guardia Sergio, Lardelli-Claret Pablo, Vilar-López Raquel, López-Espuela Fidel, Guerrero-López Francisco, Fernández-Mondéjar Enrique
Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain; Doctoral Program in Clinical Medicine and Public Health, University of Granada, Granada, Spain.
Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain; CIBER of Epidemiology and Public Health, Granada, Spain; Instituto de Investigación Biosanitaria IBS, Granada, Spain.
Gac Sanit. 2019 Jan-Feb;33(1):4-9. doi: 10.1016/j.gaceta.2017.06.006. Epub 2017 Aug 5.
The effect of drugs other than alcohol on severity of trauma remains unclear. Pooled data analyses in previous studies that grouped substances with opposite effects on the central nervous system (CNS) may have masked the influence of substances on injury severity. The aim was to analyze the effect of stimulant, hallucinogenic and depressant drugs other than alcohol on injury severity in trauma patients.
The presence of alcohol, stimulant drugs (cocaine, amphetamines and methamphetamines), depressant drugs (benzodiazepines, opiates, methadone and barbiturates) and hallucinogenic drugs (THC and PCP) was analyzed in 1187 patients between 16 and 70 years old admitted to a trauma hospital between November 2012 and June 2015. Injury severity was determined prospectively as the Injury Severity Score. A multivariate analysis was used to quantify the strength of association between exposure to substances and trauma severity, using the presence of alcohol as a stratification variable.
Drugs other than alcohol were found in 371 patients (31.3%): 32 (2.7%) stimulants, 186 (15.3%) depressants, 78 (6.6%) hallucinogenics and 75 (5.6%) polydrug use. The presence of CNS depressant substances was associated with increased injury severity only in patients also exposed to alcohol, with an adjusted odds ratio of 4.63 (1.37-15.60) for moderate injuries and 7.83 (2.53-24.21) for severe.
CNS depressant drugs had a strong influence on injury severity in patients who screened positive for alcohol consumption.
除酒精外其他药物对创伤严重程度的影响尚不清楚。以往研究中对中枢神经系统（CNS）有相反作用的物质进行分组的汇总数据分析可能掩盖了这些物质对损伤严重程度的影响。本研究旨在分析除酒精外的兴奋剂、致幻剂和抑制剂药物对创伤患者损伤严重程度的影响。
对2012年11月至2015年6月间收治于一家创伤医院的1187例年龄在16至70岁之间的患者，分析其是否存在酒精、兴奋剂药物（可卡因、苯丙胺和甲基苯丙胺）、抑制剂药物（苯二氮卓类、阿片类、美沙酮和巴比妥类）以及致幻剂药物（四氢大麻酚和苯环己哌啶）。前瞻性地将损伤严重程度确定为损伤严重度评分。以是否存在酒精作为分层变量，采用多变量分析来量化接触这些物质与创伤严重程度之间的关联强度。
在371例患者（31.3%）中发现了除酒精外的其他药物：32例（2.7%）为兴奋剂，186例（15.3%）为抑制剂，78例（6.6%）为致幻剂，75例（5.6%）为多药合用。仅在同时接触酒精的患者中，中枢神经系统抑制剂物质的存在与损伤严重程度增加相关，中度损伤的调整比值比为4.63（1.37 - 15.60），重度损伤为7.83（2.53 - 24.21）。
中枢神经系统抑制剂药物对酒精检测呈阳性的患者的损伤严重程度有很大影响。
