Acetaminophen toxicity: suicidal vs. accidental.
Acetaminophen toxicity: suicidal vs. accidental.
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DOI：
10.1186/cc1475
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发表时间：
2002-04
期刊：
影响因子：
--
通讯作者：
Parikh CR
中科院分区：
文献类型：
--
作者：
Gyamlani GG;Parikh CR
对乙酰氨基酚中毒可导致肝毒性，这是我们医疗保健系统的一个负担，并且是重症监护病房收治和住院费用的重要影响因素。我们研究的目的是确定各类对乙酰氨基酚中毒的流行病学情况，并根据入院特征分析其结果。
我们确定了1996年至1999年52个月期间在我们的城市县医院因对乙酰氨基酚中毒住院的93例连续患者。利用从病历中获取的数据进行了回顾性病例对照分析。
在此期间，对乙酰氨基酚占所有中毒入院病例的7.5%。在93例患者中，80例被归类为自杀性中毒，13例因试图缓解疼痛而意外中毒。男女比例为2∶1。在研究的93例患者中，88例在最初的24 - 48小时被收入重症监护病房进行监测。自杀性过量服用组的对乙酰氨基酚峰值水平更高（平均121.7 ± 97.0毫克/升对比64.5 ± 61.8毫克/升，P < 0.05），高于意外中毒组。尽管如此，氨基转移酶峰值水平>1000国际单位/升在后者中更常见（39%对比12%，P < 0.05）。肝性昏迷和死亡在意外过量服用组中更常见（15%对比0%，P < 0.05）。有趣的是，慢性酒精滥用在意外过量服用类别中也更频繁（39%对比18%，P = 0.05）。
尽管自杀组的对乙酰氨基酚峰值水平显著更高，但治疗失误的病例具有更高的发病率和死亡率。对乙酰氨基酚峰值水平与肝功能障碍、发病率和死亡率相关性较差。
我们建议，对乙酰氨基酚自杀性过量服用且无任何伴随中毒的患者，可以在普通内科病房安全管理。
Acetaminophen toxicity, which can lead to hepatotoxicity, is a burden on our health care system and contributes significantly to intensive care unit admissions and cost of hospitalization. The aim of our study was to determine the epidemiology of various types of acetaminophen poisoning and analyze their outcome compared with their admission characteristics. We identified 93 consecutive patients, hospitalized for acetaminophen toxicity over a 52-month period from 1996 to 1999 in our urban county hospital. Retrospective case-control analysis was carried out using the data obtained from the medical records. Acetaminophen accounted for 7.5% of all cases of poisoning admitted during this period. Of the 93 patients, 80 were classified as suicidal and 13 had accidentally poisoned themselves in an attempt to relieve pain. The ratio of females to males was found to be 2:1. Of the 93 patients studied, 88 were admitted to the intensive care unit for initial 24–48 hours of monitoring. Peak acetaminophen levels were higher in the suicidal overdose group (mean 121.7 ± 97.0 mg/l vs 64.5 ± 61.8 mg/l, P < 0.05) than in the accidental group. In spite of this, peak aminotransferase levels >1000 IU/l were more often seen in the latter (39% vs 12%, P < 0.05). Hepatic coma and death were seen more often in the accidental overdose group (15% vs 0%, P < 0.05). Interestingly chronic alcohol abuse was also more frequent in the accidental overdose category (39% vs 18%, P = 0.05). Although the peak acetaminophen level in the suicidal group was significantly higher, cases of therapeutic misadventure had higher rates of morbidity and mortality. Peak acetaminophen levels correlate poorly with hepatic dysfunction, morbidity and mortality. We recommend that the patients with suicidal acetaminophen overdose, without any concomitant poisoning, can safely managed on the medical floors.
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影响因子：
24.5
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MUTIMER, DJ;AYRES, RCS;ELIAS, E
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