Non-targeted screening for novel psychoactive substances among agitated emergency department patients
Non-targeted screening for novel psychoactive substances among agitated emergency department patients
复制标题
急诊科躁动患者中新型精神活性物质的非针对性筛查
DOI：
10.3109/15563650.2016.1139714
复制
发表时间：
2016
影响因子：
3.3
通讯作者：
R. Gerona
中科院分区：
文献类型：
--
作者：
D. Lung;N. Wilson;F. Chatenet;Clémence Lacroix;R. Gerona
抽象上下文：新型精神活性物质正以前所未有的速度被制造和引入，造成频繁、大规模的流行病。目前，在美国临床环境中识别出的大肠杆菌仅限于回顾性病例或小聚类分析。目标：本研究的目的是评估非靶向综合药物筛选在急诊科（艾德）设置的激越患者中的效用。材料与方法：这是一项前瞻性、观察性病例系列研究，在城市一级创伤中心的艾德急诊室进行，每年约有65，000例患者参加年度普查。由于当苯二氮卓类药物的初始剂量被认为不足时，氟哌啶醇被用作二线化学抑制剂是该机构的常见临床实践，因此我们推测艾德，精神激越严重到足以接受这两种药物的艾德患者亚组可能是氟哌啶醇的使用者。在1个月内，每两周一次的药房药物审计确定了其中49名患者。这些患者中有23例有足够的剩余血液样本用于分析。使用液相色谱-飞行时间质谱法（LC-TOF/MS; LC 1260，TOF/MS 6230，Agilent）分析来自储存血液样品的血清。进行了回顾性病历审查，以确定患者的临床信息。结果如下：六个患者样品产生七种不同的β-内酰胺酶：JWH-073、JWH-081、JWH-200、亚甲二氧基苄基哌嗪、甲氧麻黄酮、甲氧西他胺和赫卡因。结论：这项研究表明，在选定的艾德患者人群中进行前瞻性、非靶向的筛查在识别AML方面是可行和有效的。
Abstract Context: Novel psychoactive substances (NPS) are being created and introduced at an unprecedented rate, causing frequent, large-scale epidemics. Current identification of NPS in clinical settings in the USA is limited to the retrospective case or small cluster analysis. Objective: The purpose of this study was to assess the utility of non-targeted comprehensive drug screening in the agitated patients in an emergency department (ED) setting. Materials and methods: This is a prospective, observational case series that was conducted in the ED of an urban Level I Trauma Center with an annual census of approximately 65,000 patients per year. Since it is common clinical practice at this facility for haloperidol to be used as a second-line chemical restraint when initial dose(s) of benzodiazepines are deemed insufficient, we surmised that the subset of ED patients with psychomotor agitation severe enough to receive both these pharmaceuticals would be likely users of NPS. For 1 month, biweekly pharmacy medication audits identified 49 of these patients. There were sufficient, remaining blood samples from 23 of these patients for analysis. Serum from stored blood samples was analyzed using liquid chromatography-time-of-flight mass spectrometry (LC-TOF/MS; LC 1260, TOF/MS 6230, Agilent). Retrospective chart review was done to identify patient clinical information. Results: Six patient samples yielded seven different NPS: JWH-073, JWH-081, JWH-200, methylenedioxybenzylpiperazine, mephedrone, methoxetamine, and herkinorin. Conclusion: This study demonstrates that prospective, non-targeted NPS screening in a selected ED patient population is feasible and effective in identifying NPS.