Jonasson U, Jonasson B, Holmgren P, Saldeen T
Department of Forensic Medicine, University of Uppsala, Sweden.
Forensic Sci Int. 1998 Sep 28;96(2-3):135-42. doi: 10.1016/s0379-0738(98)00116-9.
The prevalence of dextroproxyphene (DXP) in the total medico-legal autopsy material in Sweden during 1992 to 1996 was examined. Simultaneous findings of paracetamol and alcohol in the blood were considered in the analyses. DXP in peripheral blood was found in 1782 (7.5%) of the 23,691 cases analysed during 1992-1996. The autopsy prevalence of DXP increased by 25% from 1992 to 1996. The mean blood DXP concentration was 1.62 micrograms/g (the blood level of DXP after a therapeutic dose is 0.05-0.75 microgram/g). The blood DXP level was < 0.75 microgram/g in 947 cases and > or = 0.75 microgram/g in 835 cases. The cases < 50 years of age had a significantly higher mean concentration (2.36 micrograms/g) than those > or = 50 years (1.04 micrograms/g). Paracetamol in the blood was found in 53% of the DXP cases (mean 75.0 micrograms/g; therapeutic level 2.5-25 micrograms/g) and alcohol in 43% (mean level 0.14%). According to the death certificates 54% (956) died from fatal poisoning. Among these, 74% (707) showed a blood DXP concentration > or = 0.75 microgram/g. Other Scandinavian countries, Denmark and Norway have reduced the rate of fatal DXP poisonings through government regulations for prescription. As the defined daily dose/1000 inhabitants during a 12-month period (DDD) of DXP preparations in Sweden (14.4 in 1996) is six times as high as in Denmark and nine times as high as in Norway, introduction of similar regulations in Sweden should be considered.
对1992年至1996年期间瑞典所有法医尸检材料中右丙氧芬（DXP）的流行情况进行了检查。分析中考虑了血液中同时发现对乙酰氨基酚和酒精的情况。在1992 - 1996年分析的23,691例病例中，1782例（7.5%）外周血中发现了DXP。从1992年到1996年，DXP的尸检流行率增加了25%。血液中DXP的平均浓度为1.62微克/克（治疗剂量后DXP的血药浓度为0.05 - 0.75微克/克）。947例血液中DXP水平<0.75微克/克，835例≥0.75微克/克。年龄<50岁的病例平均浓度（2.36微克/克）显著高于年龄≥50岁的病例（1.04微克/克）。53% 的DXP病例血液中发现了对乙酰氨基酚（平均75.0微克/克；治疗水平为2.5 - 25微克/克），43% 的病例发现了酒精（平均水平0.14%）。根据死亡证明，54%（956例）死于致命中毒。其中，74%（707例）血液中DXP浓度≥0.75微克/克。其他斯堪的纳维亚国家丹麦和挪威通过政府对处方的规定降低了致命DXP中毒的发生率。由于瑞典DXP制剂在12个月期间的定义日剂量/1000居民数（DDD）（1996年为14.4）是丹麦的6倍，是挪威的9倍，因此应考虑在瑞典引入类似规定。
