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研究生:吳俊昇
研究生(外文):Chun-Sheng Wu
論文名稱:台灣甲基安非他命之急性中毒型態及結果,1986年至2008年:以毒物中心為基礎之一項研究
論文名稱(外文):Pattern and Outcome of Acute Methamphetamine Poisoning in Taiwan, 1986-2008: a Poison Center Study
指導教授:楊振昌楊振昌引用關係
指導教授(外文):Chen-Chang Yang
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:環境與職業衛生研究所
學門:工程學門
學類:環境工程學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:英文
論文頁數:57
中文關鍵詞:急性中毒藥物濫用高體溫甲基安非他命
外文關鍵詞:acute poisoningdrug abusehyperthermiamethamphetamine
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前言:
濫用甲基安非他命已成為日益嚴重的全球性問題。急性甲基安非他命中毒會造成很多併發症,諸如心血管、神經、腎臟、及其他病變,如橫紋肌溶解症及高體溫等。本研究之目的在藉由行政院衛生署暨台北榮民總醫院合作之毒藥物防治諮詢中心(台灣毒藥物防治諮詢中心)之資料庫,以更加瞭解台灣甲基安非他命之中毒型態及結果。

材料與方法:
吾人首先由台灣毒藥物防治諮詢中心之資料庫中,選取1986至2008年間與甲基安非他命暴露有關的個案。之後經由個案資料的回顧,在排除單純諮詢非中毒之病患、不相關之暴露個案、一般資料不完整之個案、及慢性中毒之個案後,收集相關病患之基本資料、臨床症狀、及結果等。吾人並進一步針對其中檢驗值及臨床資料較完整的至台北榮總就醫的病患進行詳細的統計分析。

結果:
從1986年至2008年,台灣毒藥物防治諮詢中心共有502位病人,其中包括208位至台北榮總就醫的病患,符合本研究之分析條件。台灣毒藥物防治諮詢中心之病患平均年紀為25.7歲,台北榮總病患之平均年紀則為26.9歲。台灣毒藥物防治諮詢中心組有54人死亡,而至台北榮總就醫之病患則有17人死亡。在台灣毒藥物防治諮詢中心組之病人,收縮壓、脈搏及體溫與病患是否死亡有統計學上之顯著差異。至於在台北榮總就醫的病患,體溫、急性腎衰竭則與病患是否死亡有關。

結論:
體溫過高、急性腎衰竭、及血流動力學的改變可能與甲基安非他命中毒後是否死亡有關。高體溫會造成多重器官衰竭,及進一步之死亡。在甲基安非他命中毒且體溫過高之病患,藉由苯二氮平類或巴比妥酸鹽類藥物、肌肉鬆弛劑以產生藥物性麻痺、及快速的外部降溫以迅速控制體溫是最重要的處置措施。
Introduction:
Methamphetamine (MA) abuse is a global problem on the rise. Acute MA poisoning could cause many medical complications, including cardiovascular, neurological, renal, and other events such as rhabdomyolysis and hyperthermia. The aims of this study were to analyze the data collected by the Taiwan National Poison Control Center (PCC-Taiwan) to better understand the pattern and outcome of MA poisoning in Taiwan.

Patients and Methods:
We first retrieved the data regarding MA exposure reported to the PCC-Taiwan between 1986 and 2008. We then reviewed all the case inquiries and abstracted the information on patients’ demographic data, clinical manifestations, and outcomes after excluding patients with information inquiry only, patients with unrelated exposure, patients with incomplete general information, and patients with chronic MA poisoning. We also conducted a more detail analysis on a subgroup of patients who were admitted to the Taipei Veterans General Hospital (Taipei VGH) and who had more complete laboratory and clinical information.

Results
From 1986 through 2008, five hundred and two patients reported to the PCC-Taiwan, including 208 patients admitted to the Taipei VGH, were eligible for analysis. The mean age of patients reported to the PCC-Taiwan was 25.7 years old, while the mean age was 26.9 years old among patients admitted to the Taipei VGH. Fifty-four deaths were noted among patients reported to the PCC-Taiwan, and 17 deaths occurred in the Taipei VGH group. In the PCC-Taiwan group, systolic blood pressure, pulse rate, and body temperature were significantly different between the survivors and the deceased. In the Taipei VGH group, body temperature and acute renal failure were associated with the risk of death.

Conclusions
Hyperthermia, acute renal failure, and hemodynamic alterations might be associated with the risk of death following acute MA poisoning. Hyperthermia may cause multiorgan failure and subsequent death. Rapid temperature control in hyperthermic patients by means of benzodiazepines or barbiturates, pharmacologic paralysis by muscle relaxants, and rapid external cooling is the mainstay in the management of acute MA poisoning.
Contents page
Chapter 1. Introduction 1
Chapter 2. LiteraturesReviews 2
2.1. Epidemiology of MA Abuse 2
2.2. Pharmacology of MA 3
2.3. Methamphetamine- related complications 4
2.3.1. Cardiovascular complications 4
2.3.2. Neurological complications 6
2.3.3. Rhabdomyolysis 7
2.3.4. Hyperthermia 8
Chapter 3. Materials and Methods 10
3.1. Patients and Methods 10
3.2. Statistical Analysis 11
Chapter 4. Results 13
Chapter 5. Discussion 16
5.1. Methamphetamine-related Emergency 16
5.2. Annul Numbers of MA Poisoned Patients 17
5.3. Relation between Gender and MA Poisoning 18
5.4. Relation between Age and MA Poisoning 18
5.5. MA-induced Alterations in Hemodynamic Effects 19
5.6. MA-induced Hyperthermia 19
5.7. Study Limitations 20
5.8. Managements of Acute MA Poisoning 22
Chapter 6. Conclusions 24
References 25

Table Contents page
Table 1 The annual numbers of patients with acute methamphetamine poisoning and numbers of deaths in both the poison center (PCC-Taiwan) group and the Taipei Veterans General Hospital (VGH) group 28
Table 2 Distribution of demographic data between survivors and deceased patients following acute methamphetamine poisoning reported to the PCC-Taiwan 29
Table 3 Distribution of demographic data between survivors and deceased patients following acute methamphetamine poisoning who were admitted to the Taipei Veterans General Hospital 30
Table 4 Distribution of laboratory data between survivors and deceased patients following acute methamphetamine poisoning who were admitted to the Taipei Veterans General Hospital 31
Table 5 Life-threatening complications in the VGH group 32
Table 6 Causes of death in the VGH group 33
Table 7 Univariate analysis of the baseline characteristics potentially associated with the risk of death following acute methamphetamine poisoning among patients reported to the PCC-Taiwan 34
Table 8 Univariate and multivariate analyses of the risk factors of death following acute methamphetamine poisoning among patients reported to the PCC-Taiwan 35
Table 9 Univariate and multivariate analyses of the risk factors of severe/death outcome following acute methamphetamine poisoning among patients reported to the PCC-Taiwan. 36
Table 10 Univariate analysis of the baseline characteristics potentially associated with the risk of death following acute methamphetamine poisoning among patients who were admitted to the Taipei Veterans General Hospital 37
Table 11 Univariate and multivariate analyses of the risk factors of death following acute methamphetamine poisoning among patients who were admitted to the Taipei Veterans General Hospital 38
Table 12 Univariate and multivariate analyses of the risk factors of death following acute methamphetamine poisoning among patients who were admitted to the Taipei Veterans General Hospital (Severe hyperthermia instead of Body temperature) 39
Table 13 Univariate analysis of the baseline characteristics potentially associated with the development of severe/fatal outcome following acute methamphetamine poisoning among patients who were admitted to the Taipei Veterans General Hospital 40
Table 14 Univariate and multivariate analyses of the risk factors of severe/death outcome following acute methamphetamine poisoning among patients who were admitted to the Taipei Veterans General Hospital 41
Figure 1. Annual case fatality death among patients reported to the PCC-Taiwan 42
Figure 2. Annual case fatality death among patients who were admitted to the Taipei Veterans General Hospital 43
Figure 3. Annual number of patients reported to the PCC-Taiwan between 1998 and 2008 and corresponding figures of seized amount of methamphetamine in Taiwan 44
Figure 4. Annual number of patients admitted to the Taipei Veterans General Hospital between 1998 and 2008 and corresponding figures of seized amount of methamphetamine in Taiwan 45
Figure 5. Annual number of patients reported to the PCC-Taiwan between 1998 and 2008 and corresponding numbers of patients reported by the Taiwan Psychiatric Hospital Reporting System 46
Figure 6. Annual number of patients admitted to the Taipei Veterans General Hospital between 1998 and 2008 and corresponding numbers of patients reported by the Taiwan Psychiatric Hospital Reporting System 47
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