The hazards of gastric lavage for intentional self-poisoning in a resource poor location
The hazards of gastric lavage for intentional self-poisoning in a resource poor location
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DOI：
10.1080/15563650601006009
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发表时间：
2007-01-01
影响因子：
3.3
通讯作者：
Buckley, Nick A.
中科院分区：
文献类型：
--
作者：
Eddleston, Michael;Haggalla, Sapumal;Buckley, Nick A.
Objective.在发展中国家发现的10-20%的自我中毒死亡率与西方发现的0.5%明显不同。这可能部分解释了为什么西方国家最近放弃使用洗胃的运动没有在发展中国家得到效仿。在注意到斯里兰卡洗胃可能造成的危害后，我们进行了一项观察性研究，以确定洗胃是如何常规进行的，以及并发症的发生率。案例系列。在四家医院观察了14次连续洗胃。对不能或不愿意进行强制呕吐的患者进行灌洗，无论他们是否同意或自摄入后经过的时间。它也被用于服用非致命性英格玛的患者。意识减退患者的气道很少受到保护，每个周期给予大量液体（200至超过1000 ml），未使用监测。观察到可能由灌洗引起的严重并发症，包括心脏骤停和可能的液体吸入。卫生保健工作者认为灌洗是非常有效的，往往挽救生命，有同行和相对压力穿孔灌洗自我中毒患者。结论.在资源贫乏的地区，对剧毒毒物进行洗胃是危险的。在没有证据表明灌洗对患者有益的情况下（并且与一些当地指南一致），我们认为应该考虑对少数患者进行灌洗-在那些最近服用了可能致命剂量的毒药，并且口头同意该程序或接受镇静剂和插管的患者中。理想情况下，应进行随机对照试验，以确定在该患者人群中安全进行洗胃的风险和获益平衡。
Objective. The 10-20% case fatality found with self-poisoning in the developing world differs markedly from the 0.5% found in the West. This may explain in part why the recent movement away from the use of gastric lavage in the West has not been followed in the developing world. After noting probable harm from gastric lavage in Sri Lanka, we performed an observational study to determine how lavage is routinely performed and the frequency of complications. Case series. Fourteen consecutive gastric lavages were observed in four hospitals. Lavage was given to patients unable or unwilling to undergo forced emesis, regardless of whether they gave consent or the time elapsed since ingestion. It was also given to patients who had taken non-lethal ingestions. The airway was rarely protected in patients with reduced consciousness, large volumes of fluid were given for each cycle (200 to more than 1000 ml), and monitoring was not used. Serious complications likely to be due to the lavage were observed, including cardiac arrest and probable aspiration of fluid. Health care workers perceived lavage as being highly effective and often life-saving; there was peer and relative pressure to perforin lavage in self-poisoned patients. Conclusions. Gastric lavage as performed for highly toxic poisons in a resource-poor location is hazardous. In the absence of evidence for patient benefit from lavage, (and in agreement with some local guidelines), we believe that lavage should be considered for few patients - in those who have recently taken a potentially fatal dose of a poison, and who either give their verbal consent for the procedure or are sedated and intubated. Ideally, a randomized controlled trial should be performed to determine the balance of risks and benefits of safely performed gastric lavage in this patient population.