急診室不當使用藥物自殺行為之臨床特性探討及利用液相層析質譜儀定量常見自殺藥物濃度

Abstract

自殺是全球重要的社會公共議題與醫學議題，自殺是台灣第十一大死因，藥毒物是台灣自傷及企圖自殺者最常使用的方式，但此族群的背景及藥物種類尚未被研究。急診室是自殺行為者第一個尋求協助的醫療單位，辨識毒藥物種類及濃度有助於中毒判斷及死因確立，液相層析質譜儀已普遍運用在臨床及法醫毒藥物鑑別實務，但常見自殺藥物之定量方法仍尚未開發。此篇研究目的為探討急診室中不當使用藥物自殺行為者之臨床特性，以及利用液相層析質譜儀定量常見自殺藥物濃度。本研究使用國際診斷分類編碼，篩選出2017年11月至2021年5月台大醫院急診室使用藥物參與自殺行為之病患，統計其基本資料、生理與心理疾病史、藥物濫用史、檢驗報告、會診紀錄，以及使用之藥物種類。研究發現有生理與心理疾病史、過去自殺史，及目前失眠困擾者占研究族群的多數，自殺原因以健康問題為主，住院比例為16.5%，加護病房住院率為0.8%，死亡率0%。在自殺行為中，精神科藥物最常被使用，其中又以苯二氮平類最常見。本研究利用液相層析質譜儀開發血漿中常見自殺藥物的定量方法，並進行方法確效，進一步應用於實際案例。本文之病歷研究限制為病歷數較少及有資料遺漏，實驗限制為儀器測量極限、藥物間可能的訊號干擾以及藥物種類限制，未來期許能在使用藥物的自殺行為者之年齡層或性別上有更詳細的研究，並希望有其他檢測方法彌補液相層析質譜儀的偵測缺點。

Suicide is a serious global public health and medical issue. In Taiwan, suicide is the eleventh cause of death. Self-poisoning by liquid or solid substances is the most common method used by suicide attempters. However, the characteristics of self-poisoners and the substances ingested have not been clarified. The purpose of this study is to interpret the characteristics of drug misusers involved in suicide behaviors and to establish multiple-drugs detection methods by liquid chromatography-tandem mass spectrometry (LC-MS/MS). Suicidal patients involved in drugs were enrolled at the emergency department of National Taiwan University Hospital by the International Classification of Disease-Clinical Modification (ICD-CM). The electronic medical records were collected from November 2017 to May 2021. Females, aged 20-29, single, and individuals who were university-educated and blue-collared were the main demographics in our study population. More than a half of the participants had a history of psychiatric diseases, physical diseases, suicide attempts, or current insomnia. Health problems were the major suicide motive. The admission rate was 16.5%, the ICU admission rate was 0.8% and the mortality rate was 0%. Psychotropics, benzodiazepine in particular, was the most common drug used in suicide behaviors. Sixty-nine medications and twenty metabolites commonly used in suicide behaviors were determined through three LC-MS/MS methods. The methods were validated and applied. Due to limited information on medical records and the difficulties of multiple drug detection by LC-MS/MS, further studies are needed to understand the drugs used among various age and sex groups and more methods should be sought to complement the limitation of LC-MS/MS.