苯丙胺类毒品与吗啡急性中毒机制及临床治疗的比较

Comparison of acute poisoning mechanism and clinical treatment of amphetamines and morphine

目的:比较苯丙胺类毒品与吗啡急性中毒的症状、体征、实验室检查、治疗经验及直接致死原因的差异。方法:分组比较:中毒组是我科2005-2010收治的40例病例,其中20例苯丙胺类急性中毒患者为实验小组,男性15例,女性5例,平均年龄32岁;另20例吗啡急性中毒患者为对照小组,男性13例,女性7例,平均年龄46岁,对临床资料进行回顾性分析。猝死组是我市2000-2010经尿液或血液检验为毒品中毒致死者40例,其中20例因吸食苯丙胺类猝死者为实验小组,男性17例,女性3例,平均年龄35岁;另20例吸食吗啡中毒猝死者为对照小组,其中男性18例,女性2例,平均年龄47岁;对尸检报告进行综合分析。结果:中毒组中苯丙胺类中毒者血压增高达75%,呼吸增快达80%,窦性心动过速达100%;吗啡中毒者血压下降达75%,呼吸减慢达80%,窦性心动过速达100%;猝死组中尸检时发现苯丙胺类中毒者心脏有明显病变,吗啡中毒者主要以肺脏病变为主。结论:苯丙胺类可引起心肌细胞严重损害,导致急性心力衰竭,而吗啡则引起急性肺水肿,诱发呼吸衰竭,而且两者临床应用解毒药纳络酮疗效也不同。

Objective：Summarize acute amphetamine and morphine poisoning in patients with symptoms of poi- soning,signs,laboratory tests, treatment experience and direct cause of death. Method： Poisoning group include40 cases adopted by our division from 2005 to 2010.20 cases of Amphetamine acute poisoning patients are in experi mental group, 15 males and 5 female,with average age of 32 years-old;Morphine poisoning group is the contrasted group,has 20 cases of poisoning,include 13 males and 7 females, with average age of 46-years-old. Give retrospec tive analysis of clinical data;Sudden death group were drug poisoning dead tested by the urine or blood tests from 2000 to 2010 of city, 20 cases of sudden death due to abuse of amphetamine formed the experimental group, 17 males and 3 females,average age of 35-year-old;the other 20 cases taking morphine formed the contrasted group, 18 males and 2 females,average age of 47 year-old. Give comprehensive analysis of the autopsy report. Result： Ex- perimental group of poisoning group： blood pressure increased 75%, 80% faster breathing, sinus tachycardia 100%; contrasted group ： blood pressure decreased 75%, 80% slower breathing, and sinus tachycardia 100%. For sudden death group, through autopsy, Amphetamine poisoning dead were found those obvious lesions in hearts, morphine poisoning dead were found mainly pulmonary disorders. Conclusion： Amphetamines can cause serious damage to myocardial cells,lead to acute heart failure;and morphine more lead to acute pulmonary edema,induce respiratory failure. Efficacy of clinical antidote naloxone is different.