GC-MS法测定急诊病人血液中的唑吡坦（英文）

Determination of Zolpidem in Blood Samples from Emergency Patients Using GC-MS

社会快速变化导致的压力和/或诱惑,使得药物中毒正愈发显著地逐年增多,因而成为急救医学的一个突出方面。故建立一个快速准确的筛选方法从而鉴定中毒物质就显得尤为必需。但在韩国急救室环境下这样的一种系统性毒物毒理学研究仍不充分。因此,本研究旨在通过使用GC-MS仪器系统建立一个快速准确的方法以鉴定所涉药物,并对药物浓度与临床症状之间的关系作评估,从而为病人的恰当治疗提供借鉴和依据。为此,我们收集了2015年2至7月入住忠南国立大学医院的80位病人的血样,并以GC-MS进行分析。结果发现,唑吡坦是检出率最高的药物,共有15例,病人中唑吡坦的浓度在19.63～3605.85ng/mL之间,病人年龄从20到88岁。其中有5例(33%)企图自杀的病人仅服用了唑吡坦,另外10例则还选择了其他药品(一种或几种)配合使用。这些药品中,酒精3例;但曲马多被选配得最多,有4例;接下来是醋氨酚(亦即对乙酰氨基酚)3例;曲唑酮和氯苯吡胺各2例。另外,阿普唑仑、氯氮平、苯海拉明、喹硫平分别检出1次。80岁以上年龄病人组的唑吡坦浓度最高,但这与格拉斯哥昏迷评分、心理变化、服药剂量以及药物中毒后已过时间等因素却没有关联性。这很可能与服药量和/或同其他药品一起使用的准确信息缺乏有关。应可推断,所观察到的个体表现差异更多地与病人的代谢状况而不是服药剂量具有相关性。全部15例病人包括唑吡坦浓度最高者都在几天之内大为好转并出院。故唑吡坦用药过量的症状是中度的,并不会造成进一步的伤害。本研究对于完善分析体系从急救室病人样品中检测毒品能起到补充作用,对指导合理用药剂量有借鉴意义,对毒代动力学研究建立一套快速恰当的治疗程序具有帮助价值。此外,本文相关信息和结论对于法医毒理学确定与检测涉及唑吡坦中毒的死亡也有助益。

In accordance with the tension and/or temptation from rapid changes in society,intoxication is significantly increasing year by year and becoming a remarkable presence in emergency medicine.It is necessary to establish a fast and accurate screening method to identify the toxicants,but research for such systematic toxicological analysis in emergency room setting is insufficient in Korea.Hence,the purpose of this study was to establish a fast and accurate method for identifying the drugs using GC-MS and to evaluate the correlation between the blood concentration of drugs and the clinical symptoms for proper treatment of patients.In order to set up the analytical method,blood specimens were collected from 80 patients who were admitted to Chungnam National University Hospital from February to July in 2015 and were analyzed by GC-MS.As a result,zolpidem was the most frequent drug,detected in 15 cases,showing its blood concentration ranging from 19.63 to 3605.85 ng/mL in the patients aging from 20 to 88 years old.5 of the cases were patients who ingested zolpidem for suicide attempt(33%).Ingestion of zolpidem alone was in 5 cases and ingestion with other drugs in 10 cases.Alcohol was detected in 3 cases.The most common drug taken together was tramadol,detected in 4 cases,followed by acetaminophen in 3 cases,and trazodone and chlorpheniramine in 2 cases,respectively.Alprazolam,clozapine,diphenhydramine and quetiapine were each detected once.The zolpidem concentration was the highest among the patients in their 80s(older than 80 years),but there was no correlation with GCS score,mental change,the ingested amount or elapsed time after intoxication.This is most likely due to the lack of accurate information on the ingested dose and other substances.It is supposed that the difference observed in each individual is associated with metabolism rather than ingested dose.All of 15 patients including those with high zolpidem concentrations improved within a few days and were discharged.Symptoms of intoxication by zolpidem overdose were moderate,no further damage observed.This study will supplement the analytical system for detecting toxicants from samples of emergency room patients,information of correct dosage,and toxicokinetics exploration to establish a procedure for fast and appropriate treatment.Besides,it will provide useful information for determining intoxication deaths related to zolpidem in forensic toxicology.