急诊科225例急性中毒者的调查与临床分析

本文对阳泉市第一人民医院急诊科１９８９年１１月－１９９４年１１月，５年间共收治抢救的苯二氮Ｚｈｕｏ卓类急性中毒者２２５例进行调查分析。其中２４例为混合中毒，２０１例为单纯苯二氮Ｚｈｕｏ中毒，将结果与５ａ前病例进行对比，二类精神药品苯二氮Ｚｈｕｏ一倍，呈明显上升趋势。     

急诊科173例中毒者的调查与分析

本文对第三临床医学院急诊科１９９３年７月－１９９４年６月全部病历进行调查，将结果与５ａ前文献进行对比，表明酒精中毒增加了一倍多，二类精神药品中苯二氮　类中毒频率最高，呈明显上升趋势。调查未发现麻醉药品中毒，一类精神药品中毒得到控制，反映了本地依赖性药物和物质的流行特点。     

急诊科173例中毒者的调查与分析

本文对第三临床医学院急诊科１９９３年７月－１９９４年６月全部病历进行调查，将结果与５ａ前文献进行对比，表明酒精中毒增加了一倍多、二类精神药品中苯二氮卓类中毒频率最高，呈明显上升趋势，调查未发现麻醉药品中毒，一类精神药品中毒得到控制，反映了本地依赖性药物和物质的流行特点。     

口服大量苯并二氮卓类药物中毒分析

目的：分析口服大量苯并二氮卓类药物（BZD）中毒反应的特点及其与其他药物的相互反应。方法：收集我院2010年3月～2014年7月确诊的急性苯并二氮卓类药物中毒14例患者资料进行回顾性分析。结果：口服大量苯并二氮卓类药物发生严重的中毒症状甚至死亡多与其他药物相互作用引起。结论：在急诊抢救工作中,诊断为苯并二氮卓类药物中毒,必须及时采取积极有效的抢救治疗措施。     

谷胱甘肽与纳洛酮合用治疗苯二氮类药物中毒68例

目的：探讨谷胱甘肽加纳洛酮治疗苯二氮撸类药物中毒的疗效。方法：苯二氮撸类药物中毒６８例（男性２２例，女性４６例，年龄３８±ｓ７ａ）以谷胱甘肽０．６～１．２ｇ加入５％葡萄糖注射液５００ｍＬ中静脉滴注，纳洛酮０．４～０．８ｍｇ静脉推注，ｑｄ，疗程１～３ｄ；对照组６４例（男性２０例，女性４４例，年龄３６±７ａ）以尼可刹米０．３７５ｇ×５支，洛贝林３ｍｇ×５支加入５％葡萄糖注射液５００ｍＬ中静脉滴注，ｑｄ，疗程３～５ｄ。用Ｇｌａｓｇｏｗ量表确定昏迷程度，观察２组病情，意识障碍改善情况。结果：２组临床总有效率均为１００％。组间比较Ｐ＞０．０５。谷胱甘肽与纳洛酮组恢复意识障碍时间６．０±２．０ｈ，较对照组（１１±８ｈ）提前。结论：谷胱甘肽与纳洛酮合用对苯二氮撸类药物中毒的疗效与尼可刹米加洛贝林相近。     

苯二氮类精神药品中毒69例临床分析

［摘要］目的探讨苯二氮类精神药品中毒的相关因素，及时做好救治防范措施，加强二类精神药品的管理。方法分析69例苯二氮类精神药物中毒患者的中毒原因、临床表现、救治过程与防范措施。结果69例患者中女55例，男14例，年龄3～81岁。中毒人群：农民、学生、工人、干部。中毒原因：2例为误服，其余均有自杀意识。临床表现为昏睡、肌张力低下、共济失调等锥体外系症状，严重者有脑水肿、血压下降、呼吸抑制，临床救治多为对症治疗。结论苯二氮类药物中毒发生率逐年增高，加强该类药品购买、销售管理，提高医务人员的责任心是防止该类药物中毒的根本措施。     

纳洛酮对苯二氮类中毒致昏迷患者80例疗效

目的探讨纳络酮作为一种特异性阿片受体拮抗剂对苯二氮类中毒致昏迷患者的疗效。方法将我院急诊科2004年2月至2007年5月收治的160例苯二氮类中毒致昏迷者随机分为2组,治疗组80例,在常规治疗基础上使用纳洛酮;对照组80例,常规行洗胃、吸氧、利尿、解毒及对症治疗。结果苯二氮类中毒致昏迷者纳洛酮组与对照组总有效率和病死率经统计学处理差异有显著性(P<0.01)。结论纳洛酮虽非特效解毒药但其应用可使苯二氮类中毒患者清醒时间明显提前,不良反应小,并且清醒后出现嗜睡、头昏乏力、纳差等症状较轻,是一种安全、有效、值得推广应用的治疗药物。     

苯二氮类精神药品中毒69例临床分析

目的探讨苯二氮类精神药品中毒的相关因素,及时做好救治防范措施,加强二类精神药品的管理。方法分析69例苯二氮类精神药物中毒患者的中毒原因、临床表现、救治过程与防范措施。结果69例患者中女55例,男14例,年龄3~81岁。中毒人群:农民、学生、工人、干部。中毒原因:2例为误服,其余均有自杀意识。临床表现为昏睡、肌张力低下、共济失调等锥体外系症状,严重者有脑水肿、血压下降、呼吸抑制,临床救治多为对症治疗。结论苯二氮类药物中毒发生率逐年增高,加强该类药品购买、销售管理,提高医务人员的责任心是防止该类药物中毒的根本措施。     

纳洛酮治疗60例苯二氮(艹卓)类药物中毒临床分析

目的：观察纳洛酮治疗苯二氮[艹卓]类药物中毒的临床疗效。方法：选用60例苯二氮[艹卓]类药物中毒患者，入院后采取常规洗胃利尿排泄、输液等治疗外，主要用纳洛酮治疗。观察疗效并进行统计学分析。结果：疗效较好，全部60例患者除一例死亡外，其余59例均治愈出院，成功率为98．3％。结论：纳洛酮治疗苯二氮[艹卓]类药物中毒见效快，简便，价格便宜，疗效确切，副作用少。     

苯二氮(艹卓)类精神药品中毒69例临床分析

目的 探讨苯二氮(艹卓)类精神药品中毒的相关因素,及时做好救治防范措施,加强二类精神药品的管理.方法 分析69例苯二氮(艹卓)类精神药物中毒患者的中毒原因、临床表现、救治过程与防范措施.结果 69例患者中女55例,男14例,年龄3～81岁.中毒人群:农民、学生、工人、干部.中毒原因:2例为误服,其余均有自杀意识.临床表现为昏睡、肌张力低下、共济失调等锥体外系症状,严重者有脑水肿、血压下降、呼吸抑制,临床救治多为对症治疗.结论 苯二氮(艹卓)类药物中毒发生率逐年增高,加强该类药品购买、销售管理,提高医务人员的责任心是防止该类药物中毒的根本措施.     

Efficacy of flumazenil in acute alcohol intoxication: double blind placebo-controlled evaluation.

Flumazenil acts as an antidote for pharmacological and toxic effects due to benzodiazepines. Several isolated observations and short uncontrolled series have also suggested a possible effect against the impairment of consciousness induced by pure alcohol intoxication. Patients admitted in the emergency department with coma related to acute alcohol (ALC) or pure benzodiazepine (BZD) intoxication were randomized and treated blindly with either placebo or 1 mg flumazenil. A modified Glasgow score was used to observe the evolution of consciousness. In the 18 ALC patients, 1 mg flumazenil was not more effective than placebo, whereas it appeared to be very active in the BZD group. However, an open administration of higher doses of flumazenil (2-5 mg) in 11 ALC patients, whose condition had not initially improved, was followed by clear improvement of consciousness in five of them. Flumazenil, administered at a dose usually active against BZD sedation, does not improve CNS depression induced by ALC intoxication. Higher doses could be more effective in some patients, but it should also be verified in a placebo-controlled trial.     

Lead induced thiamine deficiency in the brain decreased the threshold of electroshock seizure in rat.

Many neurological disorders that occur frequently in lead intoxicated animals, have also been observed in thiamine deficient animals. To test whether lead intoxication could decrease the thiamine status and thresholds of electroshock seizure in rats, 3-week-old Wistar rats were treated with lead or lead plus thiamine. For comparison, a thiamine deficient group was included. Thiamine contents and transketolase activity, one of the thiamine dependent enzymes in the brain regions were significantly lowered by lead intoxication and thiamine deficiency. In both cases, thresholds of the electroshock seizure were significantly decreased. Thiamine supplementation reversed these signs and decreased the brain lead concentration in the lead treated group. The results from the present study suggest that the increased seizure susceptibility induced by lead intoxication in rats may be mediated at least in part through the changes of thiamine status.     

Changing the minimum legal drinking age--its effect on a central city emergency department

AIMS: To quantify the effect of a recent national law change on the presentation of ethanol intoxicated patients to a central city Emergency Department (ED). METHODS: All records of ethanol intoxicated patients presenting to the ED for twelve months before and after the change to the minimum legal drinking age were studied. Each patient was classified as having laboratory confirmed intoxication, clinical suspicion only, or no record of intoxication. Three age groups were identified, 15-17 year olds, eighteen and nineteen year olds and over 20 year olds. Within each age group the proportion of presentations with ethanol intoxication was compared across the two time periods. RESULTS: The number of intoxicated 18 and 19 year olds increased in the twelve months after the national law change from 66 to 107 (52 to 80 for laboratory confirmed intoxication and fourteen to 27 for clinical suspicion only). This represented an increase in the proportion of presentations in this age group with intoxication (p=0.009) from 2.9% to 4.4%, a 50% increase (RR=1.51, 95%CI 1.11-2.03). There was no evidence of an increase in the proportion intoxicated for those over nineteen years (3.4% vs 3.3%, p=0.48, RR=0.97, 95%CI=0.89-1.06) although the numbers increased slightly (963 to 992). However there was a worrying trend for an increase in the 15-17 year olds, with numbers increasing from 72 to 95 and the proportion increasing from 5.0% to 6.7% (p=0.07, RR=1.35, 95%CI=0.98-1.88). CONCLUSION: The recent lowering of the minimum legal drinking age from 20 to eighteen years has resulted in increased presentations to the ED of intoxicated eighteen and nineteen year olds. A similar trend was seen in the 15-17 year olds.     

Bracken fern (Pteridium aquilinum) poisoning in cattle in southern Brazil

Epidemiological data on Pteridium aquilinum intoxication in cattle the state of Santa Catarina were obtained by review of diagnostic records from 1987 to 2001. Of 3,407 necropsied cattle, 244 (7.16%) were diagnosed as intoxicated by Paquilinum; 122 of those were of the hemorrhagic form, 103 had tumors in the upper digestive tract, 19 were cases of chronic hematuria. Annual losses due to this intoxication in this State are estimated at 10,657 cattle. The highest incidence of the hemorrhagic form occurs in 1-3-y-old cattle between March and July, and most cases of tumors of the upper digestive tract affect cattle older than Sy. The highest incidence of digestive tract tumors is at the base of the tongue and pharynx, and the lowest frequency is in the rumen and esophagus. The large economic losses caused PaQuilinum in Santa Catarina call for improved control measures for the disease.     

Researching the intoxicated: informed consent implications for alcohol and drug research

This article considers the informed consent process in relation to carrying out research with intoxicated participants in 'field' research settings. There is little discussion in the literature of the potential problems that the intoxication of research participants may pose to research. Intoxication is a potential problem for all researchers but is heightened in field research that takes place in settings where participants are likely to be intoxicated, such as licensed venues, in drug consumption rooms, or police custody suites. The risks to research participants that intoxication poses should not be resolved by electing not to do research with intoxicated participants; it is argued that these risks can be managed to some extent, and are offset by the benefits of such research. Moreover, intoxication (and the impairment of cognitive functions relevant to valid informed consent) may not always be identifiable through behavioural or biochemical methods of detection. The search for accurate and field-practical methods for identifying intoxication amongst participants is useful, but not the only strategy for researchers who want to ensure the validity of the consent process. Suggestions are provided for devising research protocols that acknowledge and accept intoxication of research participants and attempt to protect them. One solution is to side-step identification of intoxication per se as a strategic objective in the consent process, and turn instead to established methods for ensuring that information has been understood by potential research participants.     

海洛因依赖伴发意识障碍与苯二氮滥用关系

目的了解海洛因依赖者脱毒时伴发意识障碍与苯二氮     

Comprehensive drug screening by integrated use of gas chromatography/mass spectrometry and Remedi HS

The authors evaluated an integrated approach for the screening of drugs in biosamples consisting of gas chromatography/mass spectrometry analysis of serum or whole blood (SB/GC-MS) and of high-performance liquid chromatographic and ultraviolet (HPLC-UV) analysis of urine with the REMEDi HS Biorad system (U/REM) (Bio-rad; Segrate, MI, Italy). Urine and blood samples from 26 suspected intoxicated patients and from 22 suspected lethal poisoning cases were examined. Eighty-one of the 99 parent drugs/main metabolites detected were identified by SB/GC-MS and 54 with U/REM. Thirty-six drugs/metabolites were identified with both methods, 45 by SB/GC-MS alone, and 18 by U/REM alone. Absence of the mass spectrometry (MS) spectra in the reference library and high polarity of the analytes were the main reasons for failed identification by SB/GC-MS. Unsuccessful identifications with U/REM were basically caused by the absence of the UV spectra in the reference library or by low chromatographic and spectroscopic selectivity as in the case of barbiturates and benzodiazepines (BZD), which represented 11% and 51%, respectively, of the 45 SB/GC-MS unique identifications. Urine samples of 14 BZD-positive cases were also submitted to enzymatic hydrolysis and analyzed with the REMEDi UBz assay, and results were compared with those obtained by SB/GC-MS: 14 of the 22 identified BZD were detected with both methods, three by U/REM only, and five by SB/GC-MS only. In conclusion, the integrated use of SB/GC-MS and U/REM approaches greatly enhances the amount and quality of analytical information obtainable by applying either method alone.     

The onset of drinking and intoxication among university students

To study the effect of the onset of drinking on subsequent alcohol use, self-administered questionnaires were completed by 856 unmarried undergraduate students from two universities in the southeastern region of the United States. The present study focuses on the 524 (61.2%) students who reported using alcohol at least occasionally. In this subsample, the strongest predictors of the extent of undergraduate intoxication are the frequency of intoxication at the onset of drinking and age at the onset. The more often an individual drinks to intoxication and the younger that individual begins to drink, the more frequently he or she will become intoxicated when a university student. Racial differences in the extent of undergraduate intoxication were also found. White students were markedly more prone to intoxication than were Black students. Sex differences, although not statistically significant, showed a tendency for drunkenness among male undergraduates to exceed that among female undergraduates. The implications of the findings for intervention and prevention strategies are discussed.     

Intergenerational Hazardous Alcohol Use and Area Factors: The HUNT Study,Norway

Background: Alcohol use among adolescents has been found to be associated with parental alcohol abuse, but it's relation to more prevalent forms of hazardous drinking patterns among parents has been less explored. Few studies have included area factors when investigating alcohol use across generations. Objectives: The aims of this study were to investigate whether adolescent intoxication was associated with parental heavy episodic drinking (HED) and intoxication, area-level socioeconomic status (SES), and rates of area-level HED. Methods: General Estimation Equations (GEE) was applied to analyze data from the Nord-Trøndelag Health Study (2006–08) including 2,306 adolescents. Adolescent alcohol use was defined by self-reported frequency of intoxication. Parental alcohol use was defined by parental self-reports of drinking five glasses of alcohol at one occasion (HED), whether they had been strongly intoxicated, and adolescent reports of seeing parents intoxicated. Area-level SES and HED were based on data from HUNT3 and Statistics Norway. Results: Parental and offspring alcohol use were associated, although this varied to some extent with gender and exposures. The strongest associations were found between offspring intoxication and offspring reports of seeing their parent intoxicated (girls: OR 3.3, 95% CI 2.3–4.7; boys: OR 3.4, 95% CI 2.4–4.7). Intoxication was more common among girls, who lived in areas with a higher level of adult HED. Living in areas with higher SES was associated with less intoxication among adolescents. Conclusion: Intoxication in adolescence was associated with factors at both family and area level, which emphasize the need of both population and high risk preventive approaches.     

Rate of onset of drunkeness. A preliminary study

Of eight moderate drinkers drinking until they became intoxicated, four left relatively sober prior to a rapid increase in sensations of intoxication, and four experienced a gradual progression to intoxication.