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頁籤選單縮合
題 名 | 國軍毒物中毒諮詢與鑑定之研究=Study of Poison Consultation and Confirmation in the Army |
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作 者 | 林裕峰; 劉紹興; 徐如瑋; 陳金順; 李安榮; | 書刊名 | 中華職業醫學雜誌 |
卷 期 | 5:1 1998.01[民87.01] |
頁 次 | 頁1-14 |
分類號 | 418.81 |
關鍵詞 | 氣相層析質譜儀; 酵素免疫分析儀; 安非他命; 嗎啡; 毒藥物鑑定及諮詢; EMIT; GC/MS; Amphetamine; Morphine; Poison identification; Poison consultation; |
語 文 | 中文(Chinese) |
中文摘要 | 毒物中心是醫院內相當重要的課題。以三軍總醫院為例,每年中毒病患有兩百例 之多。民國 79 年國內正興起安非他命風潮,更突顯處理毒藥物中毒之必要性。當時馬院長 任職軍醫局局長和沈院長乃排除萬難,全力支持成立國軍毒物中心。于局長任內奉總長令於 81 年 1 月 16 日正式成立〞國軍臨床毒物中心 "。自此時起,國軍醫療單位擁有自己的毒 物中心,嘉惠國軍官兵及一般民眾。職與李安榮教官及劉紹興教官並積極於計劃期間發展各 項毒藥物之偵測。目前我們可以鑑定之項目,包括安非他命及嗎啡等各種迷幻藥;巴拉 刈及巴拉松等農藥;甲醇及乙醇等各種有機溶劑;鎮定劑及安眠藥;不明毒藥物之鑑定及中 藥摻用西藥之研究等。計劃期間,我們完成安非他命鑑定 811 例,鴉片、嗎啡 184 例,安 眠藥及鎮定劑 106 例、巴拉刈 48 例, 有機磷 28 例,甲醇及乙醇 12 例、中藥摻用西藥 102 例。安非他命之檢體共 881 件,檢篩陽性者為 81 件 (9.2%);經氣相層析質譜儀法鑑 定後,發現 71 件真正含有甲基安非他命 (8%),6 件為偽陽性 (7.4%)。酵素免疫分析法篩 檢海洛因之檢體共 184 件,結果顯示篩檢陽性者為 31 件 (16.8%); 經氣相層析質譜儀法 鑑定後,發現 23 件為嗎啡 ( 海洛因 )(12.5%)。7 件為 Codeine,偽陽性率 (22.5%)。酵 素免疫分析法之敏感度為 100%,專一性則分別為 98.7%( 安非他命 ) 及 95%( 海洛因 ); 然而偽陽性率偏高 ( 安非他命 7.4%,嗎啡 22.5% )。氣相層析質譜儀之敏感度及專一性均 為 100% 且沒有偽陽性或偽陰性。氣相層析質譜儀法準確度及精密度均優於酵素免疫分析法 。 使用巴拉刈農夫中毒可能性之研究,結果顯示 36 位農夫中有 12 位 (33.3%) 於噴灑後 尿液可偵測到巴拉刈濃度為 29.01 ± 19.24ng/ml。這些農夫第二天的尿液則檢測不到巴拉 刈。 36 位農夫的血清均檢測不到巴拉刈。12 位尿液篩檢測到巴拉刈的農夫中有 6 位未穿 雨鞋 (p<0.01),5 位未戴口罩 (p<0.05),7 位未戴手套 (p<0.01)。 為進一步了解國內中 藥摻入西藥之盛行率及種類, 乃選取三軍總醫院腎臟科及風濕免疫科 284 位門診及住院病 患,調查其服用中藥之盛行率;並以高度敏感及高專一性之氣相層析質譜法,檢測中藥摻用 西藥的病患有 170 位,比例達到 59.8%; 另外,102 件中藥檢體中,有 23 位摻混一至六 種西藥成分, 其盛行率高達 22.5%。 檢出成分包括非固醇止痛劑 mefenamic acid 及 ibuprofen 8 例, 止痛劑 acetaminophen 4 例, 鎮定劑 diazepam 10 例, 安眠藥 phenobarbital 1 例,抗鬱劑 imipramine 1 例, 肌肉鬆弛劑 benzoxazolone 2 例,抗組 織胺 4 例,興奮劑 caffeine 13 例,維他命 E4 例,維他命 B1 10 例。 根據檢驗結果, 我們可以給予病患最完善之醫療照護;醫護人員也有明確的治療方針,家屬也不必長途奔波 送檢體。 毒物諮詢是毒物中心的重要任務。我們接受諮詢及治療安非他命中毒共 263 例, 安眠藥 106 例,嗎啡 86 例,農藥 46 例,有機溶劑 18 例及不明毒藥物中毒 102 例。我 們均給於適當的檢驗及治療,並提供相關的參考資料及協助。教學方面,職負責醫護人員有 關於中毒方面的教學。我們希望培育更多有志於臨床毒物研究之人才,以加強國軍毒物中心 之陣容,並發揮毒物中心之功能。 |
英文摘要 | Clinical toxicology has important role in the field of emergency medicine. every year, there were about two hundred patients being admitted on account of poison intoxication at Tri-Service General Hospital. Increasing amphetamine abuse took place at the end of 1990 which further emphasized that Army Clinical Toxicology Lab at TSGH could be established on Jan 16 1992. We then grandually developed methodology of measuring and identifying posions and drugs including amphetamine, morphine, heroin, paraquat, organophosphate, ethanol, methanol, sedatives, unknow poisons and drugs mized in herb drugs. We have achieved a great deal of poison measurement including 881 amphetamine, 184 poiate, 106 sedatives, 48 paraquat, 28 organophosphate, 12 methanol and ethanol and 102 herb drug screen. During study peroid 881 samples were analysed using EMIT; 81(9.2%)samples were positive for amphetamine in which 71(8%)samples were positive for methamphetamine using GC/MS and 6(7.4%) out of 81 samples wrer false positive. Detction of heroin using EMIT in 184 samples showed 31 (16.8%) samples positive while GC/MS showed 23 (12%) samples positive for morphine (heroin) and 7 (22.5) out of 31 samples were false positive due to codeine. The sensitivity of EMIT reached 100%, without false positive or false negative results. The results of paraquat study showed that 12 out of 36 farmers revealed detectable urinary paraquat with mean concentration of 29.01 ± 19.24ng/ml after spraying herbicide. Urinary paraquat could not be detected not week later. The amount of serum paraquat of all farmers was below the detection limit (10 ng/ml). Among the 12 farmers who excreted paraquat, 6 were free of rain-shoes, 5 free of masks and 6 free of gloves while among the 24 farmers who did not excrete paraquat, 2 were free of rain-shoes (P<0.01), 2 free of masks (P<0.05) and 1 free of gloves (P<0.01). To better understand and assess the safety of the herb drugs made in the mainland China and Taiwan area, we investigatd 102 herb drugs provided by patients from the Section of Nephrology and Rheumatology at Tri-Service General Hospital. Gas chromatography/mass spectrometry with high sensitivity and high specificity was applied for detection. The results showed that 59.9% patients had experience of taking Chinese herb drugs. Twenty-three samples(22.5%) out of one hundred and two herb drugs were found illegally adulterated with medications. Medications mixed in the herb drugs consisted of eight nonsteroid antiinflammatory drugs (NSAIDs) mefenamic acid and ibuprofen; four analgesics (acetaminophen); eleven sedatives ( diazepam an phenobarbital); four antihistamines(cholrpheniramine); thirteen sitmulants(caffeine);four vitamin E and ten vitamine B1. We have been offerring the best service and care for the poisoning patients, the best guidline of treatment for the medical staffs and the best servie for the family. Poison consulation is equally important as Toxicology Lab. Up tp date we have been consulted with amphetamine, 263 cases; sedatives, 106 cases; morphine, 86 cases; paraquat and organophosphate, 46 cases; organic solven, 18 cases and unknown poisons, 102 cases. We also treated patients emergently or offered some information about poisons for these patients.We also teach staffs about poison inforamtion, treatment and measurement. We hope that more staffs interested in Clinical Toxicology will join us that Toxicoloty Lab will be well developed and offer more services, research and teching porgrams. |
本系統中英文摘要資訊取自各篇刊載內容。