UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

中毒患者的胃肠道去污染

Authors
Robert G Hendrickson, MD
Shana Kusin, MD
Section Editors
Stephen J Traub, MD
Michele M Burns, MD, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM
Translators
李毅, 主任医师，教授

引言

胃肠道去污染指功能性地清除经胃肠道(gastrointestinal, GI)摄入的毒素，从而减少其吸收。过去采取过很多方法，包括胃排空[催吐或者洗胃(gastric lavage, GL)]、胃内结合[最常用的是通过单次剂量活性炭(single-dose of activated charcoal, SDAC)或者多剂量活性炭(multidose activated charcoal, MDAC)]或者加快毒素排泄以减少总吸收时间(全肠道灌洗或者导泻)。随着临床实践进展以及对胃肠道去污染方法的疗效、风险以及获益的了解加深，许多治疗手段已经停止使用。

本专题概述了成人中毒后胃肠道去污染的方法并总结了支持这些方法的证据。特定药物中毒的处理以及中毒患者(包括儿童)的一般处理见其他专题。 (参见“成人药物中毒的一般处理方法”和“不明原因物质过量重症成人的初始处理”和“Approach to the child with occult toxic exposure”)

胃肠道去污染的方法

尚无临床对照试验证实胃肠道去污染的“常规”运用降低了中毒患者的并发症发病率和死亡率。然而，来自人类志愿者试验和临床研究的证据表明，去污染可能会减少胃肠道毒素的吸收并可能在一些特定的情况下有益[1-3]。

实施胃肠道去污染的决定应基于具体摄入的毒物、从摄入到就诊的时间、就诊时表现的症状以及预测的中毒严重程度。胃肠道去污染最可能使如下患者受益：

●摄入毒物后迅速就医者(通常在1-2小时之内)

                                     

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-06 . | This topic last updated: 2017-01-24.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Chyka PA, Seger D, Krenzelok EP, et al. Position paper: Single-dose activated charcoal. Clin Toxicol (Phila) 2005; 43:61.
  2. Position statement and practice guidelines on the use of multi-dose activated charcoal in the treatment of acute poisoning. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol 1999; 37:731.
  3. Position paper: whole bowel irrigation. J Toxicol Clin Toxicol 2004; 42:843.
  4. Olkkola KT. Effect of charcoal-drug ratio on antidotal efficacy of oral activated charcoal in man. Br J Clin Pharmacol 1985; 19:767.
  5. West L. Innovative approaches to the administration of activated charcoal in pediatric toxic ingestions. Pediatr Nurs 1997; 23:616.
  6. Gwilt PR, Perrier D. Influence of "thickening" agents on the antidotal efficacy of activated charcoal. Clin Toxicol 1976; 9:89.
  7. Minocha A, Herold DA, Bruns DE, Spyker DA. Effect of activated charcoal in 70% sorbitol in healthy individuals. J Toxicol Clin Toxicol 1984-1985; 22:529.
  8. Cooper GM, Le Couteur DG, Richardson D, Buckley NA. A randomized clinical trial of activated charcoal for the routine management of oral drug overdose. QJM 2005; 98:655.
  9. Merigian KS, Blaho KE. Single-dose oral activated charcoal in the treatment of the self-poisoned patient: a prospective, randomized, controlled trial. Am J Ther 2002; 9:301.
  10. Decker WJ, Combs HF, Corby DG. Adsorption of drugs and poisons by activated charcoal. Toxicol Appl Pharmacol 1968; 13:454.
  11. Minocha A, Herold DA, Barth JT, et al. Activated charcoal in oral ethanol absorption: lack of effect in humans. J Toxicol Clin Toxicol 1986; 24:225.
  12. Neuvonen PJ, Vartiainen M, Tokola O. Comparison of activated charcoal and ipecac syrup in prevention of drug absorption. Eur J Clin Pharmacol 1983; 24:557.
  13. Neuvonen PJ, Elonen E. Effect of activated charcoal on absorption and elimination of phenobarbitone, carbamazepine and phenylbutazone in man. Eur J Clin Pharmacol 1980; 17:51.
  14. Lapatto-Reiniluoto O, Kivistö KT, Neuvonen PJ. Activated charcoal alone and followed by whole-bowel irrigation in preventing the absorption of sustained-release drugs. Clin Pharmacol Ther 2001; 70:255.
  15. Crome P, Dawling S, Braithwaite RA, et al. Effect of activated charcoal on absorption of nortriptyline. Lancet 1977; 2:1203.
  16. Tenenbein M, Cohen S, Sitar DS. Efficacy of ipecac-induced emesis, orogastric lavage, and activated charcoal for acute drug overdose. Ann Emerg Med 1987; 16:838.
  17. Green R, Grierson R, Sitar DS, Tenenbein M. How long after drug ingestion is activated charcoal still effective? J Toxicol Clin Toxicol 2001; 39:601.
  18. Yeates PJ, Thomas SH. Effectiveness of delayed activated charcoal administration in simulated paracetamol (acetaminophen) overdose. Br J Clin Pharmacol 2000; 49:11.
  19. Sato RL, Wong JJ, Sumida SM, et al. Efficacy of superactivated charcoal administered late (3 hours) after acetaminophen overdose. Am J Emerg Med 2003; 21:189.
  20. Merigian KS, Woodard M, Hedges JR, et al. Prospective evaluation of gastric emptying in the self-poisoned patient. Am J Emerg Med 1990; 8:479.
  21. Hultén BA, Adams R, Askenasi R, et al. Activated charcoal in tricyclic antidepressant poisoning. Hum Toxicol 1988; 7:307.
  22. Spiller HA, Winter ML, Klein-Schwartz W, Bangh SA. Efficacy of activated charcoal administered more than four hours after acetaminophen overdose. J Emerg Med 2006; 30:1.
  23. Buckley NA, Whyte IM, O'Connell DL, Dawson AH. Activated charcoal reduces the need for N-acetylcysteine treatment after acetaminophen (paracetamol) overdose. J Toxicol Clin Toxicol 1999; 37:753.
  24. Kornberg AE, Dolgin J. Pediatric ingestions: charcoal alone versus ipecac and charcoal. Ann Emerg Med 1991; 20:648.
  25. Harchelroad F, Cottington E, Krenzelok EP. Gastrointestinal transit times of a charcoal/sorbitol slurry in overdose patients. J Toxicol Clin Toxicol 1989; 27:91.
  26. Isbister GK, Downes F, Sibbritt D, et al. Aspiration pneumonitis in an overdose population: frequency, predictors, and outcomes. Crit Care Med 2004; 32:88.
  27. Moll J, Kerns W 2nd, Tomaszewski C, Rose R. Incidence of aspiration pneumonia in intubated patients receiving activated charcoal. J Emerg Med 1999; 17:279.
  28. Ilkhanipour K, Yealy DM, Krenzelok EP. The comparative efficacy of various multiple-dose activated charcoal regimens. Am J Emerg Med 1992; 10:298.
  29. Mauro LS, Mauro VF, Brown DL, Somani P. Enhancement of phenytoin elimination by multiple-dose activated charcoal. Ann Emerg Med 1987; 16:1132.
  30. Park GD, Goldberg MJ, Spector R, et al. The effects of activated charcoal on digoxin and digitoxin clearance. Drug Intell Clin Pharm 1985; 19:937.
  31. Neuvonen PJ, Elonen E, Mattila MJ. Oral activated charcoal and dapsone elimination. Clin Pharmacol Ther 1980; 27:823.
  32. Skinner CG, Chang AS, Matthews AS, et al. Randomized controlled study on the use of multiple-dose activated charcoal in patients with supratherapeutic phenytoin levels. Clin Toxicol (Phila) 2012; 50:764.
  33. Eddleston M, Juszczak E, Buckley NA, et al. Study protocol: a randomised controlled trial of multiple and single dose activated charcoal for acute self-poisoning. BMC Emerg Med 2007; 7:2.
  34. de Silva HA, Fonseka MM, Pathmeswaran A, et al. Multiple-dose activated charcoal for treatment of yellow oleander poisoning: a single-blind, randomised, placebo-controlled trial. Lancet 2003; 361:1935.
  35. Atkinson SW, Young Y, Trotter GA. Treatment with activated charcoal complicated by gastrointestinal obstruction requiring surgery. BMJ 1992; 305:563.
  36. Goulbourne KB, Cisek JE. Small-bowel obstruction secondary to activated charcoal and adhesions. Ann Emerg Med 1994; 24:108.
  37. Gomez HF, Brent JA, Munoz DC 4th, et al. Charcoal stercolith with intestinal perforation in a patient treated for amitriptyline ingestion. J Emerg Med 1994; 12:57.
  38. Thanacoody R, Caravati EM, Troutman B, et al. Position paper update: whole bowel irrigation for gastrointestinal decontamination of overdose patients. Clin Toxicol (Phila) 2015; 53:5.
  39. Ly BT, Schneir AB, Clark RF. Effect of whole bowel irrigation on the pharmacokinetics of an acetaminophen formulation and progression of radiopaque markers through the gastrointestinal tract. Ann Emerg Med 2004; 43:189.
  40. Bretaudeau Deguigne M, Hamel JF, Boels D, Harry P. Lithium poisoning: the value of early digestive tract decontamination. Clin Toxicol (Phila) 2013; 51:243.
  41. Kumar VV, Oscarsson S, Friberg LE, et al. The effect of decontamination procedures on the pharmacokinetics of venlafaxine in overdose. Clin Pharmacol Ther 2009; 86:403.
  42. Vale JA, Kulig K, American Academy of Clinical Toxicology, European Association of Poisons Centres and Clinical Toxicologists. Position paper: gastric lavage. J Toxicol Clin Toxicol 2004; 42:933.
  43. Saetta JP, March S, Gaunt ME, Quinton DN. Gastric emptying procedures in the self-poisoned patient: are we forcing gastric content beyond the pylorus? J R Soc Med 1991; 84:274.
  44. Saetta JP, Quinton DN. Residual gastric content after gastric lavage and ipecacuanha-induced emesis in self-poisoned patients: an endoscopic study. J R Soc Med 1991; 84:35.
  45. Tandberg D, Diven BG, McLeod JW. Ipecac-induced emesis versus gastric lavage: a controlled study in normal adults. Am J Emerg Med 1986; 4:205.
  46. Christophersen AB, Levin D, Hoegberg LC, et al. Activated charcoal alone or after gastric lavage: a simulated large paracetamol intoxication. Br J Clin Pharmacol 2002; 53:312.
  47. Kulig K, Bar-Or D, Cantrill SV, et al. Management of acutely poisoned patients without gastric emptying. Ann Emerg Med 1985; 14:562.
  48. Pond SM, Lewis-Driver DJ, Williams GM, et al. Gastric emptying in acute overdose: a prospective randomised controlled trial. Med J Aust 1995; 163:345.
  49. Trent MS, Kim U. Cocaine packet ingestion. Surgical or medical management? Arch Surg 1987; 122:1179.
  50. Position paper: Ipecac syrup. J Toxicol Clin Toxicol 2004; 42:133.
  51. American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Poison treatment in the home. American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Pediatrics 2003; 112:1182.
  52. Curtis RA, Barone J, Giacona N. Efficacy of ipecac and activated charcoal/cathartic. Prevention of salicylate absorption in a simulated overdose. Arch Intern Med 1984; 144:48.
  53. Auerbach PS, Osterloh J, Braun O, et al. Efficacy of gastric emptying: gastric lavage versus emesis induced with ipecac. Ann Emerg Med 1986; 15:692.
  54. Tandberg D, Wood DA. Ipecac-induced emesis and gastric lavage are equally unpleasant. Vet Hum Toxicol 1988; 30:109.
  55. Albertson TE, Derlet RW, Foulke GE, et al. Superiority of activated charcoal alone compared with ipecac and activated charcoal in the treatment of acute toxic ingestions. Ann Emerg Med 1989; 18:56.
  56. Position paper: cathartics. J Toxicol Clin Toxicol 2004; 42:243.