Multiple-dose activated charcoal in acute self-poisoning: a randomised controlled trial.
Multiple-dose activated charcoal in acute self-poisoning: a randomised controlled trial.
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DOI：
10.1016/s0140-6736(08)60270-6
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发表时间：
2008-02-16
期刊：
影响因子：
168.9
通讯作者：
Warrell, David A.
中科院分区：
文献类型：
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作者：
Eddleston, Michael;Juszczak, Edmund;Buckley, Nick A.;Senarathna, Lalith;Mohamed, Fahim;Dissanayake, Wasantha;Hittarage, Ariyasena;Azher, Shifa;Jeganathan, K.;Jayamanne, Shaluka;Sheriff, M. H. Rezvi;Warrell, David A.
发展中国家农村地区故意自投毒的死亡率比工业化国家高 10 至 50 倍，主要原因是使用剧毒农药和植物。因此，我们的目的是评估在这种环境下，与不使用木炭相比，使用多剂量活性炭进行常规治疗以中断血管内或肠肝循环是否具有益处。我们在斯里兰卡三家医院进行了一项开放标签、平行组、随机对照试验，试验每隔 4 小时使用 6 剂 50 克活性炭，与不使用木炭和使用 1 剂 50 克活性炭进行比较。 4632 名患者被随机分为不接受木炭治疗 (n=1554)、接受一剂木炭治疗 (n=1545) 或接受六剂木炭治疗 (n=1533)； 4629 名患者的结果可用。 2338 人 (51%) 摄入了杀虫剂，而 1647 人 (36%) 摄入了黄色夹竹桃 (Thevetia peruviana) 种子。死亡率是主要结果指标。分析是按意向治疗进行的。该试验在 Controlled-Trials.com 上注册为 ISRCTN02920054。各组之间的死亡率没有差异。多剂量组的 1531 名参与者中有 97 名 (6·3%) 死亡，而无木炭组的 1554 名参与者中有 105 名 (6·8%) 死亡（调整后的比值比 0·96，95% CI 0·70–1·33）。对于服用特定毒物、入院时病情严重或提早就诊的患者，没有发现任何差异。我们不建议在亚太地区农村地区常规使用多剂量活性炭；尽管对早期木炭施用的进一步研究可能有用，但迫切需要有效且负担得起的治疗方法。
The case-fatality for intentional self-poisoning in the rural developing world is 10–50-fold higher than that in industrialised countries, mostly because of the use of highly toxic pesticides and plants. We therefore aimed to assess whether routine treatment with multiple-dose activated charcoal, to interrupt enterovascular or enterohepatic circulations, offers benefit compared with no charcoal in such an environment. We did an open-label, parallel group, randomised, controlled trial of six 50 g doses of activated charcoal at 4-h intervals versus no charcoal versus one 50 g dose of activated charcoal in three Sri Lankan hospitals. 4632 patients were randomised to receive no charcoal (n=1554), one dose of charcoal (n=1545), or six doses of charcoal (n=1533); outcomes were available for 4629 patients. 2338 (51%) individuals had ingested pesticides, whereas 1647 (36%) had ingested yellow oleander (Thevetia peruviana) seeds. Mortality was the primary outcome measure. Analysis was by intention to treat. The trial is registered with controlled-trials.com as ISRCTN02920054. Mortality did not differ between the groups. 97 (6·3%) of 1531 participants in the multiple-dose group died, compared with 105 (6·8%) of 1554 in the no charcoal group (adjusted odds ratio 0·96, 95% CI 0·70–1·33). No differences were noted for patients who took particular poisons, were severely ill on admission, or who presented early. We cannot recommend the routine use of multiple-dose activated charcoal in rural Asia Pacific; although further studies of early charcoal administration might be useful, effective affordable treatments are urgently needed.