住院儿童药物中毒47例临床分析与药学服务

目的 分析儿童药物中毒病例特点，探讨药师在预防和治疗儿童药物中毒过程中可提供的多样化药学服务。方法 回顾性统计分析宁波市妇女儿童医院2020年1月1日—2023 年6月30日收治的47例住院儿童药物中毒病例，并结合宁波市妇女儿童医院实际，讨论药学服务切入点。结果 药物中毒的患儿主要是青春期女孩。中毒原因多为有意服药自杀，共33例(70.21%)，另有患儿自行误服12例(25.53%)，及家长看错用药剂量导致药物过量2例(4.26%)。临床症状以嗜睡及昏睡28例，头晕16例，恶心呕吐14例，腹痛11例常见。中毒药物种类多为精神类药品，共39例(82.98%)。入院后，洗胃40例(85.11%)，血液净化11例(23.40%)，结合利尿、导泻等方式清除毒物，并根据毒物种类选用特效药物解毒，以及给予对症支持治疗，最终47例均好转、治愈出院。结论 基于儿童药物中毒的临床特点，药师可积极参与预防和诊治工作，以减少药物中毒的发生，改善中毒患儿预后。在预防方面，药师配发药品时应做好用药交代和用药宣教，尤其是对于精神类药品和剂量易混淆药品；在救治时，临床药师可从毒物的检测分析，毒物的清除，特效解毒药物的选用，药物儿童剂量的查询等多个方面对中毒患儿开展全程药学监护。

Clinical Analysis of 47 Hospitalized Children with Drug Poisoning and Pharmaceutical Care

OBJECTIVE To analyze the characteristics of drug poisoning in children, and to explore the diverse pharmaceutical services that pharmacists can provide in the process of prevention and treatment. METHODS The 47 children diagnosed as drug poisoning in Ningbo Women and Children''s Hospital from January 1, 2020 to June 30, 2023 were retrospectively enrolled. Combined with the actual situation of Ningbo Women and Children''s Hospital, pharmaceutical services were discussed. RESULTS The majority of children with drug poisoning were adolescent girls. The main cause of poisoning was intentional drug ingestion for suicide, accounting for 33 cases(70.21%). Additionally, 12 cases(25.53%) were accidental ingestion by children and 2 cases(4.26%) of drug overdose were caused by parents misreading the dosage of drugs. The clinical symptoms included drowsiness and/or lethargy(28 cases), dizziness(16 cases), nausea and/or vomiting(14 cases), and abdominal pain(11 cases). The majority of toxic substances were psychiatric drugs, accounting for 39 cases(82.98%). After hospitalization, 40 patients(85.11%) were treated with gastric lavage, and 11 patients(23.40%) were treated with blood purification. Diuresis and catharsis were also applied to remove poison. In addition, specific drug antidotes were selected according to the type of poisons. Meanwhile, symptomatic and supportive therapies were used. Finally, all 47 patients improved or cured after hospitalization. CONCLUSION Based on the characteristics of drug poisoning in children, pharmacists can actively participate in prevention and treatment, in order to reduce the occurrence of drug poisoning and improve the prognosis of poisoned children. In terms of prevention, pharmacists should provide medication instructions and education when dispensing drugs, especially for psychotropic drugs and drugs with easily confused dosage. In the treatment, clinical pharmacists can provide comprehensive pharmaceutical care for poisoned children from various aspects such as drug detection and analysis, removal of toxics, selection of specific antidotes, and inquiry of drug dosage for children.