毒物检测技术在895例临床中毒患者中的应用价值研究

Application of toxicant and drug detection in 895 patients with clinical poisoning diseases

目的本研究探索毒物检测在临床中毒疾病中的应用价值,并分析毒检阳性中毒患者的临床特征。方法本研究是多中心回顾性队列研究。共收集2020年10月1日至2022年9月30日入组参与队列研究的江苏省及周边的41家医院送至南京医科大学中毒研究所毒检中心行毒物检测鉴定的患者毒检结果、中毒情况及临床信息,分析毒检阳性即检出毒物或过量药物患者的临床特征,并对毒检采样情况与检测结果进行相关性分析。结果本研究共纳入895例进行毒检鉴定的临床诊断中毒或可疑中毒患者。其中毒检结果阳性652例,占比72.85%。所有毒检阳性患者中,接触单一毒物者506例,多种毒物者147例;检出前三位毒物(药物)为农药除草剂(202例,30.98%),镇静/精神类药物(151例,23.16%),以及农药杀虫剂(97例,14.88%)。在毒物药物暴露史明确的541例患者中,毒检阳性率为78.19%;在中毒暴露史不明确的354例患者中,毒检阳性率为64.69%。暴露史不明确的患者毒检阳性结果前三位毒物(药物)为:镇静/精神类药物(82例,12.58%)、除草剂(26例,3.99%)以及鼠药(22例,3.37%)。因不明原因意识障碍、凝血功能异常以及多脏器功能损伤入院的患者更易检出阳性结果。结论中毒疾病的暴露史存在不确定性,因尽早完善毒物检测;当患者存在意识障碍、凝血功能异常和多脏器功能损伤时,亦需要考虑完善毒检。

Objective To explore the diagnostic value of the toxicant and drug detection in clinical poisoning diseases and analyze the clinical characteristics of patients with positive poison test.Methods This study was a multicenter retrospective cohort study.Sampling and clinical information data were collected between October 1,2020 and September 30,2022 from 41 tertiary hospitals in and around Jiangsu province.The clinical characteristics of patients with positive toxicology tests were analyzed,and the correlation between the drug sampling situation and the test results was analyzed..Results A total of 895 patients with clinical diagnosis or suspected poisoning were enrolled in this study.Among them,652 patients had positive results,accounting for 72.85%.Among all positive patients,506 patients were exposed to a single poison and 147 patients were exposed to multiple poisons.The top three poisons were pesticide herbicides(202 cases,30.98%),sedative and psychotropic drugs(151 cases,23.16%),and pesticide insecticides(97 cases,14.88%).Among 541 patients with clear exposure history,the positive rate was 78.19%,and among 354 patients with unclear exposure history,the positive rate was 64.69%.The top three poisons(drugs)of patients with unclear exposure history were sedative and psychotropic(82,12.58%),herbicide(26,3.99%),and rodenticide(22,3.37%).Patients who admitted to hospital for unexplained consciousness disorder,abnormal blood coagulation function and multiple organ dysfunction were more likely to obtain positive poison test results.Conclusions There is uncertainty in the exposure history of poisoning diseases,so it is necessary to improve the detection of toxic substances as soon as possible.Toxicant testing should be considered when patients have impaired consciousness,abnormal coagulation function and multiple organ dysfunction.