Buckley N A, Whyte I M, Dawson A H, McManus P R, Ferguson N W
Discipline of Clinical Pharmacology, University of Newcastle, NSW.
Med J Aust. 1995 Feb 20;162(4):190-3. doi: 10.5694/j.1326-5377.1995.tb126020.x.
To examine the morbidity and mortality associated with self-poisoning with different drug classes.
Prospective cohort study with limited follow-up. Retrospective analysis of coronial data.
Primary and tertiary referral toxicology centre covering Newcastle and Lake Macquarie, Australia, 1987-1992.
There were 1969 admissions after ingestion of 3724 substances (2424 prescription drugs and 1300 non-prescription items). The coroner investigated 83 drug-related deaths. Only 12 of these people presented to hospital and, for most of these, death was inevitable at presentation. The most frequently ingested substances were benzodiazepines, alcohol, paracetamol, antidepressants, neuroleptics and anticonvulsants. Since 1980, the percentage of self-poisonings involving benzodiazepines has fallen, while it has risen for those involving antidepressants. Over 50% of deaths were due to tricyclic antidepressants or opioid analgesics.
As death usually occurs out of hospital, interventions to decrease mortality from self-poisoning must focus on prevention, and targeting drugs that are frequently taken or frequently lethal in overdose. Consideration should be given to the use of antidepressants that are safer in overdose. The use of antidepressants, barbiturates or chloral hydrate as sedatives should be discouraged.
研究不同药物类别所致自我中毒的发病率和死亡率。
随访有限的前瞻性队列研究。对死因裁判数据进行回顾性分析。
1987 - 1992年，澳大利亚新南威尔士州纽卡斯尔市及麦夸里湖地区的一级和三级转诊毒理学中心。
摄入3724种物质（2424种处方药和1300种非处方药）后有1969例入院治疗。死因裁判官调查了83例与药物相关的死亡病例。其中只有12人曾前往医院就诊，而且对于大多数人来说，就诊时死亡已不可避免。最常摄入的物质为苯二氮䓬类、酒精、对乙酰氨基酚、抗抑郁药、抗精神病药和抗惊厥药。自1980年以来，涉及苯二氮䓬类的自我中毒比例下降，而涉及抗抑郁药的比例上升。超过50%的死亡是由三环类抗抑郁药或阿片类镇痛药所致。
由于死亡通常发生在院外，降低自我中毒死亡率的干预措施必须侧重于预防，并针对那些经常服用或过量服用时经常致死的药物。应考虑使用过量服用时更安全的抗抑郁药。应不鼓励使用抗抑郁药、巴比妥类药物或水合氯醛作为镇静剂。
