反复过量用药：患者特征、习惯及结局
Recurrent overdose: patient characteristics, habits, and outcomes.
作者信息
Taylor D M, Cameron P A, Eddey D
机构信息
Emergency Medicine, Ballarat Base Hospital, Victoria, Australia. taylordm+@pitt.edu
出版信息
J Accid Emerg Med. 1998 Jul;15(4):257-61. doi: 10.1136/emj.15.4.257.
OBJECTIVES
Patients who overdose repeatedly on drugs and poisons (repeaters) are of major concern. This study aimed to examine the demographics, types of drugs ingested, associated self inflicted trauma, and medium term outcome of repeaters and to compare these patients with those who overdosed on one occasion only (single presenters) during the study period.
METHODS
The study was undertaken in the emergency department of a large, provincial Australian hospital. A retrospective case note examination was made for all patients who presented, after drug overdose, during the two year study period. These patients were also followed up for a further 12 months after the study period.
RESULTS
The study identified 335 single presenters and 46 repeaters. Females formed about two thirds of each group but repeaters tended to be older (p > 0.05) and to present more frequently before midnight (p > 0.05). Significantly more repeat presentations were triaged to the low priority categories 4 or 5 (odds ratio (OR) 0.48; 95% confidence interval (CI) 0.26 to 0.90, p = 0.023) and this group required fewer admissions to the hospital (OR 1.85; 95% CI 1.16 to 2.93, p = 0.009). Repeaters tended to take single drug overdoses. There were significantly more paracetamol only overdoses (OR 0.54; 95% CI 0.32 to 0.92, p = 0.024) and neuroleptic only overdoses (OR 0.27; 95% CI 0.11 to 0.67, p = 0.005) in the repeater group. More repeaters caused self inflicted trauma during the study period (OR 0.20; 95% CI 0.06 to 0.64, p = 0.007). No repeater completed suicide during the study or the 12 month follow up periods but repeaters presented more frequently, after overdose, during follow up (OR 0.38; 95% CI 0.13 to 1.11, p = 0.078).
CONCLUSIONS
The study concludes that there are some significant differences between patients who overdose repeatedly and those who overdose on one occasion only. The study findings suggest that the medium term suicidal risk for repeaters is relatively low. However, this risk will vary and individual patients must be assessed thoroughly and managed accordingly.
目的
反复过量服用药物和毒物的患者（反复过量服用者）是主要关注对象。本研究旨在调查反复过量服用者的人口统计学特征、摄入药物类型、相关的自我伤害情况以及中期结局，并将这些患者与研究期间仅一次过量服药的患者（单次就诊者）进行比较。
方法
本研究在澳大利亚一家大型省级医院的急诊科进行。对研究期间因药物过量前来就诊的所有患者进行回顾性病历检查。在研究期结束后，还对这些患者进行了为期12个月的随访。
结果
该研究确定了335名单次就诊者和46名反复过量服用者。每组中女性约占三分之二，但反复过量服用者往往年龄更大（p>0.05），且在午夜前就诊更为频繁（p>0.05）。显著更多的反复就诊者被分诊到低优先级类别4或5（优势比（OR）0.48；95%置信区间（CI）0.26至0.90，p=0.023），且该组患者住院次数较少（OR 1.85；95%CI 1.16至2.93，p=0.009）。反复过量服用者倾向于单次药物过量。反复过量服用者组中仅对乙酰氨基酚过量（OR 0.54；95%CI 0.32至0.92，p=0.024）和仅抗精神病药物过量（OR 0.27；95%CI 0.11至0.67，p=0.005）的情况显著更多。在研究期间，更多反复过量服用者造成了自我伤害（OR 0.20；95%CI 0.06至0.64，p=0.007）。在研究期间或12个月随访期内，没有反复过量服用者自杀，但反复过量服用者在随访期间过量服药后就诊更为频繁（OR 0.38；95%CI 0.13至1.11，p=0.078）。
结论
该研究得出结论，反复过量服用者与仅一次过量服药者之间存在一些显著差异。研究结果表明，反复过量服用者的中期自杀风险相对较低。然而，这种风险会有所不同，必须对个体患者进行全面评估并相应地进行管理。
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