《Lancet》：活性炭对急性农药中毒无效

fadi99

Multiple-dose activated charcoal in acute self-poisoning: a randomised controlled trial

Summary

Background
The case-fatality for intentional self-poisoning in the rural developing world is 10–50-fold higher than that in industrialised countries, mostly because of the use of highly toxic pesticides and plants. We therefore aimed to assess whether routine treatment with multiple-dose activated charcoal, to interrupt enterovascular or enterohepatic circulations, offers benefit compared with no charcoal in such an environment.
在发展中国家的农村，自杀性服毒的病死率高于发达国家10-50倍。最主要的原因是服用剧毒杀虫剂和植物。所以我们打算评估用倍剂量活性碳阻断肠循环和肠肝循环作为常规治疗的有效性。在这样一种环境下以不用活性碳为有利的对照。
Methods
We did an open-label, parallel group, randomised, controlled trial of six 50 g doses of activated charcoal at 4-h intervals versus no charcoal versus one 50 g dose of activated charcoal in three Sri Lankan hospitals. 4632 patients were randomised to receive no charcoal (n=1554), one dose of charcoal (n=1545), or six doses of charcoal (n=1533); outcomes were available for 4629 patients. 2338 (51%) individuals had ingested pesticides, whereas 1647 (36%) had ingested yellow oleander (Thevetia peruviana) seeds. Mortality was the primary outcome measure. Analysis was by intention to treat. The trial is registered with controlled-trials.com as ISRCTN02920054.
我们做了公开标签，平行组，随机、对照实验。在三家斯里兰卡医院，实验组给予50克剂量的活性碳间，每4小时1次，共6次；对照组不用活性碳；对照组用一次50克剂量的活性碳。4632例患者随机接受无活性碳治疗（n=1554），一次剂量的活性碳治疗（n=1545），6次剂量的碳治疗（n=1533）；4629例患者的实验结果有效。2338（51%）例摄入杀虫剂，1647（36%）例摄入黄色夹竹桃种子。主要测量结果是死亡率。通过治疗目的进行分析。实验在controlled-trials.com登记， ISRCTN02920054。
Findings
Mortality did not differ between the groups. 97 (6-3%) of 1531 participants in the multiple-dose group died, compared with 105 (6-8%) of 1554 in the no charcoal group (adjusted odds ratio 0-96, 95% CI 0-70–1-33). No differences were noted for patients who took particular poisons, were severely ill on admission, or who presented early.
各组之间死亡率无明显不同。与无活性碳组1554例受试者中死亡105例（占6.8%）相比，多剂量组的1531例受试者中97例（6.3%）死亡（校正后的优势比为0.96，95%CI 0.70-1.33）。服用特殊毒药者、入院时病情严重者、早期出现者之间无显著性差异。Interpretation
We cannot recommend the routine use of multiple-dose activated charcoal in rural Asia Pacific; although further studies of early charcoal administration might be useful, effective affordable treatments are urgently needed.
在亚太地区的农村，我们不推荐常规使用倍剂量的活性碳；虽然以前的研究认为早期用活性碳治疗有效，但提供得起的有效治疗才是急切的需要。