From the Departments of Pediatric Intensive Care.
Pediatrics.
J Clin Psychopharmacol. 2023;43(2):139-144. doi: 10.1097/JCP.0000000000001668. Epub 2023 Feb 16.
PURPOSE/BACKGROUND: This study aimed to compare the frequency, clinical findings, treatment practices, and outcomes of toxicity to old-generation (OG) and new-generation (NG) antidepressants in our pediatric intensive care unit (PICU) by year-to-year.
METHODS/PROCEDURES: The study included patients hospitalized for antidepressant poisoning during the 11-year period of January 2010 through December 2020. Antidepressants were classified as OG and NG. The groups were compared in terms of patient demographic characteristics, type of poisoning (accidental/suicidal), clinical findings, supportive and extracorporeal treatments received, and outcomes.
FINDINGS/RESULTS: The study included 58 patients (NG, n = 30; OG, n = 28). The median age of the patients was 178 months (range, 13.6-215 months) and 47 patients (81%) were female. Patients admitted for only antidepressant poisoning constituted 13.3% of all poisoning cases (58/436). Of these, 22 cases (37.9%) were accidental and 36 (62.3%) were suicidal. The most common cause of poisoning was amitriptyline (24/28) in the OG group and sertraline (13/30) in the NG group. Neurological symptoms were significantly more common in the OG group (76.2% vs 23.8%), while gastrointestinal involvement was more common in the NG group (82% vs 18%; P = 0.001 and P = 0.026, respectively). Old-generation antidepressant poisoning was associated with more frequent intubation (4 vs 0 patients, P = 0.048) and longer length of PICU stay (median, 1 day [range, 1-8] vs 1 day [range, 1-4], P = 0.019). Rates of therapeutic plasma exchange and intravenous lipid emulsion therapy did not differ ( P = 0.483 and P = 0.229, respectively).
IMPLICATIONS/CONCLUSIONS: In poisoned patients, proper evaluation and management of patients requiring PICU admission are vital for favorable patient outcomes.
目的/背景：本研究旨在通过逐年比较，比较我院儿科重症监护病房（PICU）中旧一代（OG）和新一代（NG）抗抑郁药中毒的频率、临床发现、治疗方法和结局。
方法/过程：本研究纳入了 2010 年 1 月至 2020 年 12 月期间因抗抑郁药中毒住院的 11 年间的患者。将抗抑郁药分为 OG 和 NG。比较两组患者的人口统计学特征、中毒类型（意外/自杀）、临床发现、接受的支持和体外治疗以及结局。
结果/发现：本研究共纳入 58 例患者（NG 组 30 例，OG 组 28 例）。患者的中位年龄为 178 个月（范围 13.6-215 个月），47 例（81%）为女性。仅因抗抑郁药中毒而入院的患者占所有中毒病例的 13.3%（58/436）。其中，22 例（37.9%）为意外中毒，36 例（62.3%）为自杀中毒。OG 组最常见的中毒药物为阿米替林（24/28），NG 组为舍曲林（13/30）。OG 组的神经症状明显更为常见（76.2%比 23.8%），而 NG 组的胃肠道受累更为常见（82%比 18%；P = 0.001 和 P = 0.026）。OG 组抗抑郁药中毒更常需要插管（4 例比 0 例，P = 0.048），PICU 住院时间更长（中位数 1 天[范围 1-8]比 1 天[范围 1-4]，P = 0.019）。治疗性血浆置换和静脉内脂肪乳剂治疗的比例无差异（P = 0.483 和 P = 0.229）。
意义/结论：在中毒患者中，对需要入住 PICU 的患者进行适当的评估和管理对于患者的良好结局至关重要。
