儿科急诊药物过量的管理路径构建与分析研究

Construction and Analysis of Management Pathways for Drug Overdose in Pediatric Emergency Departments

关键词:  药物过量  儿科  急诊  管理  路径

Key words:  drug overdose  pediatrics  emergency department  management  pathway

摘要:

目的 构建儿科急诊药物过量的管理路径，分析儿童药物过量的基本特点和用药行为，为其规范管理提供实践经验与参考依据。方法 单中心横断面研究，连续纳入2019-01-01至2025-04-30北京大学第三医院儿科急诊接诊的药物过量患者（10~16岁）。采集人口学、既往诊断、服药详情、临床表现、院前和急诊处置和转归。组建含儿科医师、护士、药师、检验师、心理咨询师的多学科小组，根据三个阶段以及高危和低危两层制订管理方案并实施流程。采用Excel和SPSS 26.0进行数据收集和统计分析。结果 儿科急诊收治的药物过量例数逐年增加，多合并精神疾病。本研究最终纳入185例，平均年龄13.94±1.00岁，女性159例（85.95%）。诊断抑郁121例（65.41%），确诊中位时间为5（2，12）月，10例（5.41%）存在多次药物过量。共记录315例次过量用药，75例（40.54%）同时服用≥2种药物，舍曲林、劳拉西泮、喹硫平报告例次居前。284条剂量记录中，有213例次（75.00%）超每日最大剂量，超量中位数为3.33（2.11，5.29）倍。所有患儿全部接受电动洗胃，中位留观7.0（4.0，10.0）小时；血药浓度监测完成233例次（73.97%）。25例（13.51%）收入院，无死亡病例。结论 本研究构建了儿科急诊药物过量的管理路径，分析了儿童药物过量的行为特征，儿童药物过量形势严峻，儿科精神药物治疗药物监测技术应用欠佳。未来应进一步完善儿童药物过量“医-护-药-心理”合作模式，剖析因素并积极构建干预策略与管理体系。

Abstract:

Objective: To establish a management pathway for pediatric emergency drug overdose cases, analyze the basic characteristics and medication behaviors of pediatric drug overdose, and provide practical experience and reference basis for standardized management. Methods: A single-center cross-sectional study was conducted, consecutively enrolling pediatric emergency patients (aged 10–16 years) with drug overdose admitted to Peking University Third Hospital from January 1, 2019, to April 30, 2025. Demographic information, previous diagnoses, medication details, clinical manifestations, pre-hospital and emergency department interventions, and outcomes were collected. A multidisciplinary team comprising pediatricians, nurses, pharmacists, laboratory technicians, and psychologists was formed to develop management protocols and implement processes based on two phases (acute and recovery) and two risk levels (high and low). Data collection and statistical analysis were performed using Excel and SPSS 26.0. Results: The number of pediatric emergency department admissions for drug overdose has increased annually, with many cases involving comorbid mental disorders. This study ultimately included 185 cases, with an average age of 13.94 ± 1.00 years and 159 females (85.95%). Depression was diagnosed in 121 cases (65.41%), with a median time to diagnosis of 5 (2, 12) months. Ten cases (5.41%) had multiple drug overdoses. A total of 315 instances of overdose were recorded, with 75 cases (40.54%) involving the concurrent use of ≥2 drugs. Sertraline, lorazepam, and quetiapine were the most frequently reported drugs. Among 284 dose records, 213 cases (75.00%) exceeded the maximum daily dose, with a median overdose of 3.33 (2.11, 5.29) times the maximum dose. All patients underwent gastric lavage, with a median observation time of 7.0 (4.0, 10.0) hours; serum drug concentration testing was completed in 233 cases (73.97%). Twenty-five cases (13.51%) were admitted to the hospital, with no deaths reported. Conclusion: This study established a management pathway for pediatric emergency drug overdose, analyzed behavioral characteristics, and highlighted the severe situation of pediatric drug overdose with inadequate application of therapeutic drug monitoring technology in pediatric psychiatric drug therapy. Future efforts should further refine the “physician-nurse-pharmacist-psychologist” collaborative model for pediatric drug overdose, analyze contributing factors, and actively develop intervention strategies and management systems.