活性炭对常见化学物经口中毒的疗效评价研究
|
摘要
我国的突发化学物经口中毒事件危害严重,如在患者中毒早期的毒物清除措施较为得当,将可降低病死率。其中口服活性炭因其吸附效能好、不良反应少、给药方便等优点,在国外常被作为毒物经口中毒早期最重要的清除措施。目前存在的问题是,国内外尚无评价其吸附效能相关系统综述或大样本RCT的文献报道,因此无法肯定化学物,特别是常见化学物经口中毒时应用活性炭的疗效及其程度。
本研究主要包括以下三部分:(1)系统地搜索已有针对活性炭对常见经口中毒化学物吸附效能研究的文献报道,归纳和总结其研究结果,筛选出研究结果不明确的常见化学物(如杀鼠剂、亚硝酸盐),以便于进一步开展体外实验和动物实验探索活性炭对其吸附效能;(2)通过体外实验评价活性炭对亚硝酸钠的吸附效能,同时探索了活性炭的应用对致死剂量和中毒剂量亚硝酸钠染毒大鼠的治疗效果;(3)通过体外实验评价活性炭对溴敌隆的吸附效能,同时评价了活性炭的应用对致死剂量染毒家兔的治疗效果。
研究结果发现:(1)目前针对常见经口中毒化学物开展的活性炭吸附效能研究文献数量少,且存在方法设计不完善和结果解释不妥的问题,难以肯定中毒事件中应用活性炭的疗效,因此,作为选题,本研究选取国内常见的经口中毒化学物亚硝酸钠和溴敌隆分别开展体外实验和动物实验探索活性炭对其吸附效能是得当的;(2)亚硝酸钠实验部分证明,体外条件下活性炭可以吸附亚硝酸钠,且其吸附率不受pH值影响,但随活性炭-亚硝酸钠质量比值而有变化;动物实验则显示,活性炭的应用不能显著延长染毒大鼠抽搐出现时间或死亡时间,不能改善其抽搐程度,不能降低其死亡率或高铁血红蛋白含量;(3)体外实验各pH值水平、各浓度水平溴敌隆溶液经活性炭吸附后均低于最低检出浓度,可以认为活性炭对溴敌隆吸附均较完全。但溴敌隆致死剂量经口染毒家兔给予活性炭治疗后,虽然血中溴敌隆浓度较未治疗组有所降低,但其PT、APTT和死亡率均没有显著性差异。
综合体外实验和动物实验结果,本研究建议在发生亚硝酸钠经口中毒时不将活性炭作为常规的救治措施,并开展相关研究,探索多次给活性炭或者降低染毒剂量后活性炭对溴敌隆中毒的治疗效果。
Incidents caused by oral poisoning of chemicals have led to great harm to China. However,fatality might be cut down,if removal measures were taken promptly at the early stage of poisoning.Activated charcoal is the most favorable chioce of gut decontamination abroad while intoxication happened because of its excellent adsorption efficacy,rare side effects and feasibility of pre-hospital treatment.The existing problem lies in that few systematic review or large sample RCT have been carried out on the adsorbing efficacy of the common chemicals by activated charcoal at home and abroad.It is,therefore,impossible to confirm the therapeutic effect as well as the degree of effect of activated charcoal in oral poisoning of common chemicals.
The present study includes three parts as follows:(1) Browse all documents related to the adsorbing efficacy of activated charcoal on chemicals that may bring to oral poisoning incidents,summarize results of those documents systematically and focus on the indefinite conclusion(such as rodenticide and nitrite) to find out subjects to be studied the therapeutic effect in vitro and in vivo;(2)The adsorption effect of activated charcoal on nitrite were studied in vitro while the therapeutic effect of activated charcoal on rats intoxicated with nitrite of lethal dose as well as toxic dose were studied in vivo;(3)The adsorption effect of activated charcoal on bromadiolone were studied in vitro and in vivo,too.
Results showed that,(1) only a few articles focusing on the adsorbing efficacy of common chemicals by activated charcoal were found,and most of which were designed imperfectly and explained inappropriately.It remained uncertain that whether activated charcoal should be used or not when oral sodium nitrite and bromadiolone poisoning incidents,two of common chemicals that may lead to oral poisoning incidents in China,break out.It's the basis of subject selected of the present study,to evaluate the adsorptive efficacy of activated charcoal in vitro and in vivo;(2) As the in vitro study had found,sodium nitrite could be adsorbed by activated charcoal,with the adsorption rate influenced by the activated charcoal-sodium nitrite ratio significantly but not by pH.The animal study,however, showed that neither convulsion alleviated or delayed,nor mortality rate or the blood metahemoglobin was decreased when activated charcoal was used;(3) The concentration of bromadiolone in each activated charcoal group was all brought down below the detection limit in vitro,which proved the effective adsorption of activated charcoal on bromadiolone.But as to animal study,the PT,APTT and mortality rate showed no improvement when activated charcoal was used for the rabbits intoxicated with bromadiolone of lethal dose,though the plasma concentration of bromadiolone did have been cut down significantly.
In conclusion,we suggest that activated charcoal would not be used as conventional treatment in oral sodium nitrites poisoning.On the other hand,more studies on the therapeutic effect of activated charcoal in bromadiolone poisoning of toxic dose as well as the therapeutic effect of multi-dose activated charcoal in bromadiolone poisoning should be carried out.
本研究主要包括以下三部分:(1)系统地搜索已有针对活性炭对常见经口中毒化学物吸附效能研究的文献报道,归纳和总结其研究结果,筛选出研究结果不明确的常见化学物(如杀鼠剂、亚硝酸盐),以便于进一步开展体外实验和动物实验探索活性炭对其吸附效能;(2)通过体外实验评价活性炭对亚硝酸钠的吸附效能,同时探索了活性炭的应用对致死剂量和中毒剂量亚硝酸钠染毒大鼠的治疗效果;(3)通过体外实验评价活性炭对溴敌隆的吸附效能,同时评价了活性炭的应用对致死剂量染毒家兔的治疗效果。
研究结果发现:(1)目前针对常见经口中毒化学物开展的活性炭吸附效能研究文献数量少,且存在方法设计不完善和结果解释不妥的问题,难以肯定中毒事件中应用活性炭的疗效,因此,作为选题,本研究选取国内常见的经口中毒化学物亚硝酸钠和溴敌隆分别开展体外实验和动物实验探索活性炭对其吸附效能是得当的;(2)亚硝酸钠实验部分证明,体外条件下活性炭可以吸附亚硝酸钠,且其吸附率不受pH值影响,但随活性炭-亚硝酸钠质量比值而有变化;动物实验则显示,活性炭的应用不能显著延长染毒大鼠抽搐出现时间或死亡时间,不能改善其抽搐程度,不能降低其死亡率或高铁血红蛋白含量;(3)体外实验各pH值水平、各浓度水平溴敌隆溶液经活性炭吸附后均低于最低检出浓度,可以认为活性炭对溴敌隆吸附均较完全。但溴敌隆致死剂量经口染毒家兔给予活性炭治疗后,虽然血中溴敌隆浓度较未治疗组有所降低,但其PT、APTT和死亡率均没有显著性差异。
综合体外实验和动物实验结果,本研究建议在发生亚硝酸钠经口中毒时不将活性炭作为常规的救治措施,并开展相关研究,探索多次给活性炭或者降低染毒剂量后活性炭对溴敌隆中毒的治疗效果。
Incidents caused by oral poisoning of chemicals have led to great harm to China. However,fatality might be cut down,if removal measures were taken promptly at the early stage of poisoning.Activated charcoal is the most favorable chioce of gut decontamination abroad while intoxication happened because of its excellent adsorption efficacy,rare side effects and feasibility of pre-hospital treatment.The existing problem lies in that few systematic review or large sample RCT have been carried out on the adsorbing efficacy of the common chemicals by activated charcoal at home and abroad.It is,therefore,impossible to confirm the therapeutic effect as well as the degree of effect of activated charcoal in oral poisoning of common chemicals.
The present study includes three parts as follows:(1) Browse all documents related to the adsorbing efficacy of activated charcoal on chemicals that may bring to oral poisoning incidents,summarize results of those documents systematically and focus on the indefinite conclusion(such as rodenticide and nitrite) to find out subjects to be studied the therapeutic effect in vitro and in vivo;(2)The adsorption effect of activated charcoal on nitrite were studied in vitro while the therapeutic effect of activated charcoal on rats intoxicated with nitrite of lethal dose as well as toxic dose were studied in vivo;(3)The adsorption effect of activated charcoal on bromadiolone were studied in vitro and in vivo,too.
Results showed that,(1) only a few articles focusing on the adsorbing efficacy of common chemicals by activated charcoal were found,and most of which were designed imperfectly and explained inappropriately.It remained uncertain that whether activated charcoal should be used or not when oral sodium nitrite and bromadiolone poisoning incidents,two of common chemicals that may lead to oral poisoning incidents in China,break out.It's the basis of subject selected of the present study,to evaluate the adsorptive efficacy of activated charcoal in vitro and in vivo;(2) As the in vitro study had found,sodium nitrite could be adsorbed by activated charcoal,with the adsorption rate influenced by the activated charcoal-sodium nitrite ratio significantly but not by pH.The animal study,however, showed that neither convulsion alleviated or delayed,nor mortality rate or the blood metahemoglobin was decreased when activated charcoal was used;(3) The concentration of bromadiolone in each activated charcoal group was all brought down below the detection limit in vitro,which proved the effective adsorption of activated charcoal on bromadiolone.But as to animal study,the PT,APTT and mortality rate showed no improvement when activated charcoal was used for the rabbits intoxicated with bromadiolone of lethal dose,though the plasma concentration of bromadiolone did have been cut down significantly.
In conclusion,we suggest that activated charcoal would not be used as conventional treatment in oral sodium nitrites poisoning.On the other hand,more studies on the therapeutic effect of activated charcoal in bromadiolone poisoning of toxic dose as well as the therapeutic effect of multi-dose activated charcoal in bromadiolone poisoning should be carried out.
引文
[1]王玲芬,赵素莲,梁京辉.全国2000-2005年重大食物中毒情况分析[J].中国卫生监督杂志.2006;13(4):280-282.
[2]卫生部.卫生部关于2001年重大食物中毒情况通报[J].中国食品卫生杂志.2002;14(3):62-63.
[3]卫生部.卫生部关于2004年第四季度重大食物中毒情况的通报[J].中国食品卫生杂志.2005;17(5):466-468.
[4]刘厚俭.急性有机磷农药中毒的急救处理[J].中国实用乡村医生杂志.2004;11(2):21-22.
[5]何凤生.中华职业医学[M].第1版.北京:人民卫生出版社;1999:789-790
[6]王菊芳,潘捷.亚硝酸钠引起集体食物中毒的急救护理[J].中华护理杂志.1999;34(2):92.
[7]医用药理学编写组.医用药理学[M].第2版.北京:人民卫生出版社;1984:487
[8]Chyka P A,Seger D,Krenzelok E P,et al.Position paper:Single-dose activated charcoal[J].Clin Toxicol.2005;43(2):61-87.
[9]http://csi.micromedex.com/DATA/TM/TM848.HTM?Top=Yes#6[DB]2008-01-17
[10]张瑜,孙承业.毒物现场快速检测方法的评价研究[D].北京:中国疾病预防控制中心,2006.
[11]Guven H,Tuncok Y,Gidener S,et al.In vitro adsorption of dichlorvos and parathion by activated charcoal[J].J Toxicol Clin Toxicol.1994;32(2):157-163.
[12]Khalil S A,Naggar V F,Zaghloul I A,et al.In vitro anticoagulant-antacid interactions[J].International journal of pharmaceutics.1984;19(3):307-321.
[13]Tuncok Y,Gelal A,Apaydin S,et al.Prevention of oral dichlorvos toxicity by different activated charcoal products in mice[J].Annals of Emergency Medicine.1995;25(3):353-355.
[1]关旭明,任爱琴,李培建.灌服活性碳对有机磷中毒动物血清胆碱脂酶的影响[J].河北医药.2001;23(3):175-176.
[15]张宏顺,孙承业,谢立璟,等.活性炭对急性毒鼠强中毒家兔的疗效研究[J].中华急诊医学杂志.2005;14(3):204-207.
[16]刘新胜,郭辉.活性炭胃肠吸附并血液灌流救治乐果中毒[J].中原医刊.1998;25(4):45.
[17]周丰美,冯志娟,鲍琴华,等.活性炭胃肠灌洗抢救重症有机磷农药口服中毒患者的临床研究[J].实用护理杂志.2000;16(9):5-6.
[18]朱茂华.胃内注入活性炭联合重复洗胃抢救中重度有机磷农药中毒的探讨[J].现代中西医结合杂志.2005;14(7):882.
[19]郭芳,曹立叶.活性炭结合排泄疗法治疗急性有机磷中毒45例临床分析[J].中国社区医师.2005;1:30.
[20]张海波,刘玉法,李丽,等.活性炭混悬剂治疗有机磷农药中毒(附60例临床分析)[J].滨州医学院学报.2000;23(5):476-477.
[21]王飞,孙海燕,姚波,等.活性炭胃肠灌洗在有机磷农药口服中毒中的临床应用[J].延安大学学报(医学科学版).2004;2(4):33.
[22]刘红,陈淑玲.活性炭吸附联合导泻救治急性有机磷中毒的疗效研究[J].齐鲁护理杂志.2006;12(10):1859-1860.
[23]陈济先.活性炭在治疗毒鼠强中毒的临床研究[J].医学信息.2006;19(2):293-294
[24]Olkkola KT,Neuvonen PJ.Effect of gastric pH on antidotal efficacy of activated charcoal in man[J].Int J Clin Pharmacol Ther Toxicol.1984;22(10):565-569.
[25]李幼平.循证医学[M].第1版。北京:高等教育出版社;2003:20-21
[26]http://www.inchem.org/documents/jecfa/jecmono/v50je05.htm[DB]2008-01-17
[27]GB/T5750.5-2006.生活饮用水标准检验方法(无机非金属指标)[S].
[28]JJG 196-2006.常用玻璃量器检定规程[S].
[29]Olkkola K T.Effect of charcoal-drug ratio on antidotal efficacy of oral activated charcoal in man[J].Br J Clin Pharmacol.1985;19(6):767-773.
[30]Bailey DN,Briggs JR.The effect of ethanol and pH on the adsorption of drugs from simulated gastric fluid onto activated charcoal[J].Therapeutic Drug Monitoring.2003;25(3):310-313.
[31]GB8788-1988.职业性急性苯的氨基、硝基化合物(三硝基甲苯除外)中毒诊断标准及处理原则[S].
[32]Ono J,Vieth RF,Walson PD.Electrocorticographical observation of seizures induced by pentylenetet razol(PTZ) injection in rats[J].Funct Neurol.1990;5(4):345-352.
[33]杜新增,张鑫,姜绍娥,等.一起溴敌隆群体中毒的法医临床学分析[J].中国法医学杂志.2003;18(1):34-35.
[34]杨选平,郭炳衡.某部一起鼠药“溴敌隆”中毒调查[J].解放军预防医学杂志.1998;16(3):229-229.
[35]闫树旭,周和冰,裴文仲,等.溴敌隆中毒48例临床分析[J].中华劳动卫生职业病杂志.1998;16(6):377.
[36]http://www.inchem.org/documents/hsg/hsg/hsg094.htm#SectionNumber:2.5[DB]2008-4-25
[37]GB/T 5009.1-2003.食品卫生检验方法 理化部分总则[S].
[38]江涛.法医毒物分析[M].第2版.北京:人民卫生出版社;1998:152
[39]HJ/T167-2004.室内环境空气质量监测技术规范[S].
[40]Houston M,Hendrickson RG.Decontamination[J].Crit Care Clin.2005;21(4):653-672.
[41]www.doc.govt.nz/upload/documents/science-and-technical/docts23b.pdf[DB]2008-06-05
[42]Robert W,Derlet M D,Albertson T E,et al.Activated Charcoal-Past,Present and Future[J].West J Med.1986;145(4):493-496.
[43]Tomimaru A,Arimori K,Inotsume N,et al.Effect of activated charcoal and atropine on absorption and/or exsorption of organophosphorus compounds in rats[J].J Pharm Pharmacol 1996;48:351-356.
[44]王迎,杨仁池,刘永泽,等.抗凝血杀鼠药中毒九例临床观察[J].中华劳动卫生职业病杂志.2006;24(6):379.
[45]Deepa S,Mishra A K.Fluorescence spectroscopic study of serum albuminbromadiolone interaction:fluorimetric determination of bromadiolone[J].Journal of Pharmaceutical and Biomedical Analysis.2005;38:556-563.
[46]http://csi.micromedex.com/DATA/HS/HS6458F.htm
[47]崔金山.医学科学研究方法,第1版.沈阳:东北大学.1995:5
[48]Green R,Grierson R,Sitar DS,et al.How long after drug ingestion is activated charcoal still effective[J].J Toxicol Clin Toxicol.2001,39:601-605.
[49]Jones S,Ali B.Activated charcoal and gastric absorption of iron compound[J].Emerg Med J.2002,19:49
[50]李连达,靖雨珍.中医药研究.第1版.北京:科学技术文献出版社.2001:30
[51]Hoegberg L C G,Angelo H R,Christophersen A B,et al.Effect of ethanol and pH on the adsorption of acetaminophen(paracetamol) to high surface activated charcoal,in vitro studies[J].J Toxicol Clin Toxicol.2002,40:59-67
[52]Mizuta K,Matsumoto T,Hatate Y,et al.Removal of nitrate-nitrogen from drinking water using bamboo powder charcoal[J].Bioresour Technol.2004,95(3):255-257.
[53]Norris W R,Temple W A,Eason C T,et al.Sorption of fluoroacetate (compound 1080) by Colestipol,activated charcoal and anion-exchange in resins in vitro and gastrointestinal decontamination in rats[J].Vet Hum Toxicol.2000,42(5):269-275.
[1]YANG R T.Adsorbents:Fundamentals and Applications[M].New York:John Wiley and Sons Inc,2003.79-123.
[2]HOEGBERG L C G,ANGELO H R,CHRISTOPHERSEN A B,et al.Effect of ethanol and pH on the adsorption of acetaminophen(paracetamol) to high surface activated charcoal,in vitro studies[J].J Toxicol Clin Toxicol.2002,40:59-67
[3]MIZUTA K,MATSUMOTO T,HATATE Y,et al.Removal of nitrate-nitrogen from drinking water using bamboo powder charcoal[J].Bioresour Technol.2004,95(3):255-257.
[4]INFOTEXT.Activated charcoal.[EB/OL].[2007-9-27]http://csi.micromedex.com/DAT /IT/IT569.HTM
[5]AVANTAGGIATO G,SOLFRIZZO M,VISCONTI A.Recent advances on the use of adsorbent materials for detoxification of Fusarium mycotoxins[J].Food Addit Contam.2005;22(4):379-388
[6]CHYKA P A,SEGER D,KRENZELOK E P,et al.Position paper:Single-dose activated charcoal[J].Clin Toxicol.2005,43(2):61-87
[7]TUNCOK Y,GELAL A,APAYDIN S,et al.Prevention of oral dichlorvos toxicity by different activated charcoal products in mice[J].Ann Emerg Med.1995,25:353-355.
[8]NORRIS W R,TEMPLE W A,EASON C T,et al.Sorption of fluoroacetate (compound 1080) by Colestipol,activated charcoal and anion-exchange in resins in vitro and gastrointestinal decontamination in rats[J].Vet Hum Toxicol.2000,42(5):269-275.
[9]GREEN R,GRIERSON R,SITAR DS,et al.How long after drug ingestion is activated charcoal still effective[J].J Toxicol Clin Toxicol.2001,39:601-605
[10]REMMERT H P,OLLING M,SLOB W,et al.Comparative antidotal efficacy of activated charcoal tablets,capsules and suspension in healthy volunteers [J].Eur J Clin Pharmacol.1990,39:501-505
[11]JONES S,ALIB.Activated charcoal and gastric absorption of iron compound[J].Emerg Med J.2002,19:49
[12]BOSSE G M,BAREFOOT J A,PFEIFER M P,et al.Comparison of three methods of gut decontamination in tricyclic antidepressant overdose [J].J Emerg Med.1995,13:203-209
[13]SPILLER H A,WINTER M L,KLEIN-SCHWARTZ W,et al.Efficacy of activated charcoal administered more than four hours after acetaminophen overdose[J].J Emerg Med.2006,30:l.
[14]LAPUS,MICHAEL R.A randomized clinical trial of activated charcoal for the routine management of oral drug overdose[J].Q J Med.2005,98:655-660
[15]CROME P,ADAMS R,ALI C,et al.Activated charcoal in tricyclic antidepressant poisoning:pilot controlled clinical trial[J].Human Toxicol.1983,2:205-209
[16]DECKER W J,COMBS H F,CORBY D G Adsorption of drugs and poisons by activated charcoal[J].Toxicol Appl Pharmacol.1968,13:454-460.
[17]PICCHIONI A L,CHIN L,VERHULST H L.Activated charcoal versus "universal antidote" as an antidote for poisons[J].Toxicol Appl Pharmacol.1966,8:447.
[18]CASSIDY S L,HALE A,BUSS D C,et al.In vitro drug adsorption to charcoal,silicas,acrylate copolymer and silicone oil with charcoal and with acrylate copolymer[J].Hum Exp Toxicol.1997;16 (1):25-27.
[19]GUVEN H.TUNCOK Y.GIDENER S,et al.In vitro adsorption of dichlorvos and parathion by activated charcoal[J].Journal of Toxicology Clinical Toxicology.1994,32 (2): 157-163.
[20]BELMOUDEN M,ASSABBANE A,ICHOU Y A.Adsorption characteristics of a phenoxy acetic acid herbicide on activated carbon[J].J Environ Monit.2000,2:257-260
[21]HAMADI N K,SWAMINATHAN S,XIAODONG C.Adsorption of Paraquat dichloride from aqueous solution by activated carbon derived from used tires[J].J Hazard Mater.2004,112(1-2):133-141
[22]IDID S Z,LEE C Y.Effects of Fuller's Earth and activated charcoal on oral absorption of paraquat in rabbits[J].Clin Exp Pharmacol Physiol.1996,23(8):679-681.
[23]张宏顺,孙承业,谢立璟,等.活性炭对急性毒鼠强中毒家兔的疗效研究[J].中华急诊医学杂志.2005,14(3):204-207.
[24]关旭明,任爱琴,李培建.灌服活性碳对有机磷中毒动物血清胆碱脂酶的影响[J].河北医药.2001;23(3):175-176.
[25]周丰美,冯志娟,鲍琴华,等.活性炭胃肠灌洗抢救重症有机磷农药口服中毒患者的临床研究[J].实用护理杂志.2000,16(9):5-6.
[26]刘红,陈淑玲.活性炭吸附联合导泻救治急性有机磷中毒的疗效研究[J].齐鲁护理杂志.2006,12(10):1859-1860.
[27]HOUSTON M,HENDRICKSON R G.Decontamination[J].Crit Care Clin.2005,21(4):653-672
[28]GAUDREAULT P.Activated charcoal revisited[J].Clin Ped Emerg Med.2005,(6):76-80
[29]LAMBERT R J,KINDLER B L,SCHAEFFER D J.The efficacy of superactivated charcoal in treating rats exposed to a lethal oral dose of potassium cyanide[J].Ann Emerg Med.1988,17(6):595-598
[30]SILVA H A,FONSEKA M M,PATHMESWARAN A,et al.Multiple-dose activated charcoal for treatment of yellow oleander poisoning:a single-blind,randomised,placebo-controlled trial[J].Lancet.2003,361:1935-1938
[31]BURTON J R,RYAN C,SHAW-STIFFEL T A.Liver transplantation in mushroom poisoning[J].J Clin Gastroenterol.2002,35(3):276-380.
[32]LAMMINP(A|¨)(A|¨) A,KINOS M.Plant poisonings in children[J].Hum Exp Toxicol.1996,15(3):245-249.
[2]卫生部.卫生部关于2001年重大食物中毒情况通报[J].中国食品卫生杂志.2002;14(3):62-63.
[3]卫生部.卫生部关于2004年第四季度重大食物中毒情况的通报[J].中国食品卫生杂志.2005;17(5):466-468.
[4]刘厚俭.急性有机磷农药中毒的急救处理[J].中国实用乡村医生杂志.2004;11(2):21-22.
[5]何凤生.中华职业医学[M].第1版.北京:人民卫生出版社;1999:789-790
[6]王菊芳,潘捷.亚硝酸钠引起集体食物中毒的急救护理[J].中华护理杂志.1999;34(2):92.
[7]医用药理学编写组.医用药理学[M].第2版.北京:人民卫生出版社;1984:487
[8]Chyka P A,Seger D,Krenzelok E P,et al.Position paper:Single-dose activated charcoal[J].Clin Toxicol.2005;43(2):61-87.
[9]http://csi.micromedex.com/DATA/TM/TM848.HTM?Top=Yes#6[DB]2008-01-17
[10]张瑜,孙承业.毒物现场快速检测方法的评价研究[D].北京:中国疾病预防控制中心,2006.
[11]Guven H,Tuncok Y,Gidener S,et al.In vitro adsorption of dichlorvos and parathion by activated charcoal[J].J Toxicol Clin Toxicol.1994;32(2):157-163.
[12]Khalil S A,Naggar V F,Zaghloul I A,et al.In vitro anticoagulant-antacid interactions[J].International journal of pharmaceutics.1984;19(3):307-321.
[13]Tuncok Y,Gelal A,Apaydin S,et al.Prevention of oral dichlorvos toxicity by different activated charcoal products in mice[J].Annals of Emergency Medicine.1995;25(3):353-355.
[1]关旭明,任爱琴,李培建.灌服活性碳对有机磷中毒动物血清胆碱脂酶的影响[J].河北医药.2001;23(3):175-176.
[15]张宏顺,孙承业,谢立璟,等.活性炭对急性毒鼠强中毒家兔的疗效研究[J].中华急诊医学杂志.2005;14(3):204-207.
[16]刘新胜,郭辉.活性炭胃肠吸附并血液灌流救治乐果中毒[J].中原医刊.1998;25(4):45.
[17]周丰美,冯志娟,鲍琴华,等.活性炭胃肠灌洗抢救重症有机磷农药口服中毒患者的临床研究[J].实用护理杂志.2000;16(9):5-6.
[18]朱茂华.胃内注入活性炭联合重复洗胃抢救中重度有机磷农药中毒的探讨[J].现代中西医结合杂志.2005;14(7):882.
[19]郭芳,曹立叶.活性炭结合排泄疗法治疗急性有机磷中毒45例临床分析[J].中国社区医师.2005;1:30.
[20]张海波,刘玉法,李丽,等.活性炭混悬剂治疗有机磷农药中毒(附60例临床分析)[J].滨州医学院学报.2000;23(5):476-477.
[21]王飞,孙海燕,姚波,等.活性炭胃肠灌洗在有机磷农药口服中毒中的临床应用[J].延安大学学报(医学科学版).2004;2(4):33.
[22]刘红,陈淑玲.活性炭吸附联合导泻救治急性有机磷中毒的疗效研究[J].齐鲁护理杂志.2006;12(10):1859-1860.
[23]陈济先.活性炭在治疗毒鼠强中毒的临床研究[J].医学信息.2006;19(2):293-294
[24]Olkkola KT,Neuvonen PJ.Effect of gastric pH on antidotal efficacy of activated charcoal in man[J].Int J Clin Pharmacol Ther Toxicol.1984;22(10):565-569.
[25]李幼平.循证医学[M].第1版。北京:高等教育出版社;2003:20-21
[26]http://www.inchem.org/documents/jecfa/jecmono/v50je05.htm[DB]2008-01-17
[27]GB/T5750.5-2006.生活饮用水标准检验方法(无机非金属指标)[S].
[28]JJG 196-2006.常用玻璃量器检定规程[S].
[29]Olkkola K T.Effect of charcoal-drug ratio on antidotal efficacy of oral activated charcoal in man[J].Br J Clin Pharmacol.1985;19(6):767-773.
[30]Bailey DN,Briggs JR.The effect of ethanol and pH on the adsorption of drugs from simulated gastric fluid onto activated charcoal[J].Therapeutic Drug Monitoring.2003;25(3):310-313.
[31]GB8788-1988.职业性急性苯的氨基、硝基化合物(三硝基甲苯除外)中毒诊断标准及处理原则[S].
[32]Ono J,Vieth RF,Walson PD.Electrocorticographical observation of seizures induced by pentylenetet razol(PTZ) injection in rats[J].Funct Neurol.1990;5(4):345-352.
[33]杜新增,张鑫,姜绍娥,等.一起溴敌隆群体中毒的法医临床学分析[J].中国法医学杂志.2003;18(1):34-35.
[34]杨选平,郭炳衡.某部一起鼠药“溴敌隆”中毒调查[J].解放军预防医学杂志.1998;16(3):229-229.
[35]闫树旭,周和冰,裴文仲,等.溴敌隆中毒48例临床分析[J].中华劳动卫生职业病杂志.1998;16(6):377.
[36]http://www.inchem.org/documents/hsg/hsg/hsg094.htm#SectionNumber:2.5[DB]2008-4-25
[37]GB/T 5009.1-2003.食品卫生检验方法 理化部分总则[S].
[38]江涛.法医毒物分析[M].第2版.北京:人民卫生出版社;1998:152
[39]HJ/T167-2004.室内环境空气质量监测技术规范[S].
[40]Houston M,Hendrickson RG.Decontamination[J].Crit Care Clin.2005;21(4):653-672.
[41]www.doc.govt.nz/upload/documents/science-and-technical/docts23b.pdf[DB]2008-06-05
[42]Robert W,Derlet M D,Albertson T E,et al.Activated Charcoal-Past,Present and Future[J].West J Med.1986;145(4):493-496.
[43]Tomimaru A,Arimori K,Inotsume N,et al.Effect of activated charcoal and atropine on absorption and/or exsorption of organophosphorus compounds in rats[J].J Pharm Pharmacol 1996;48:351-356.
[44]王迎,杨仁池,刘永泽,等.抗凝血杀鼠药中毒九例临床观察[J].中华劳动卫生职业病杂志.2006;24(6):379.
[45]Deepa S,Mishra A K.Fluorescence spectroscopic study of serum albuminbromadiolone interaction:fluorimetric determination of bromadiolone[J].Journal of Pharmaceutical and Biomedical Analysis.2005;38:556-563.
[46]http://csi.micromedex.com/DATA/HS/HS6458F.htm
[47]崔金山.医学科学研究方法,第1版.沈阳:东北大学.1995:5
[48]Green R,Grierson R,Sitar DS,et al.How long after drug ingestion is activated charcoal still effective[J].J Toxicol Clin Toxicol.2001,39:601-605.
[49]Jones S,Ali B.Activated charcoal and gastric absorption of iron compound[J].Emerg Med J.2002,19:49
[50]李连达,靖雨珍.中医药研究.第1版.北京:科学技术文献出版社.2001:30
[51]Hoegberg L C G,Angelo H R,Christophersen A B,et al.Effect of ethanol and pH on the adsorption of acetaminophen(paracetamol) to high surface activated charcoal,in vitro studies[J].J Toxicol Clin Toxicol.2002,40:59-67
[52]Mizuta K,Matsumoto T,Hatate Y,et al.Removal of nitrate-nitrogen from drinking water using bamboo powder charcoal[J].Bioresour Technol.2004,95(3):255-257.
[53]Norris W R,Temple W A,Eason C T,et al.Sorption of fluoroacetate (compound 1080) by Colestipol,activated charcoal and anion-exchange in resins in vitro and gastrointestinal decontamination in rats[J].Vet Hum Toxicol.2000,42(5):269-275.
[1]YANG R T.Adsorbents:Fundamentals and Applications[M].New York:John Wiley and Sons Inc,2003.79-123.
[2]HOEGBERG L C G,ANGELO H R,CHRISTOPHERSEN A B,et al.Effect of ethanol and pH on the adsorption of acetaminophen(paracetamol) to high surface activated charcoal,in vitro studies[J].J Toxicol Clin Toxicol.2002,40:59-67
[3]MIZUTA K,MATSUMOTO T,HATATE Y,et al.Removal of nitrate-nitrogen from drinking water using bamboo powder charcoal[J].Bioresour Technol.2004,95(3):255-257.
[4]INFOTEXT.Activated charcoal.[EB/OL].[2007-9-27]http://csi.micromedex.com/DAT /IT/IT569.HTM
[5]AVANTAGGIATO G,SOLFRIZZO M,VISCONTI A.Recent advances on the use of adsorbent materials for detoxification of Fusarium mycotoxins[J].Food Addit Contam.2005;22(4):379-388
[6]CHYKA P A,SEGER D,KRENZELOK E P,et al.Position paper:Single-dose activated charcoal[J].Clin Toxicol.2005,43(2):61-87
[7]TUNCOK Y,GELAL A,APAYDIN S,et al.Prevention of oral dichlorvos toxicity by different activated charcoal products in mice[J].Ann Emerg Med.1995,25:353-355.
[8]NORRIS W R,TEMPLE W A,EASON C T,et al.Sorption of fluoroacetate (compound 1080) by Colestipol,activated charcoal and anion-exchange in resins in vitro and gastrointestinal decontamination in rats[J].Vet Hum Toxicol.2000,42(5):269-275.
[9]GREEN R,GRIERSON R,SITAR DS,et al.How long after drug ingestion is activated charcoal still effective[J].J Toxicol Clin Toxicol.2001,39:601-605
[10]REMMERT H P,OLLING M,SLOB W,et al.Comparative antidotal efficacy of activated charcoal tablets,capsules and suspension in healthy volunteers [J].Eur J Clin Pharmacol.1990,39:501-505
[11]JONES S,ALIB.Activated charcoal and gastric absorption of iron compound[J].Emerg Med J.2002,19:49
[12]BOSSE G M,BAREFOOT J A,PFEIFER M P,et al.Comparison of three methods of gut decontamination in tricyclic antidepressant overdose [J].J Emerg Med.1995,13:203-209
[13]SPILLER H A,WINTER M L,KLEIN-SCHWARTZ W,et al.Efficacy of activated charcoal administered more than four hours after acetaminophen overdose[J].J Emerg Med.2006,30:l.
[14]LAPUS,MICHAEL R.A randomized clinical trial of activated charcoal for the routine management of oral drug overdose[J].Q J Med.2005,98:655-660
[15]CROME P,ADAMS R,ALI C,et al.Activated charcoal in tricyclic antidepressant poisoning:pilot controlled clinical trial[J].Human Toxicol.1983,2:205-209
[16]DECKER W J,COMBS H F,CORBY D G Adsorption of drugs and poisons by activated charcoal[J].Toxicol Appl Pharmacol.1968,13:454-460.
[17]PICCHIONI A L,CHIN L,VERHULST H L.Activated charcoal versus "universal antidote" as an antidote for poisons[J].Toxicol Appl Pharmacol.1966,8:447.
[18]CASSIDY S L,HALE A,BUSS D C,et al.In vitro drug adsorption to charcoal,silicas,acrylate copolymer and silicone oil with charcoal and with acrylate copolymer[J].Hum Exp Toxicol.1997;16 (1):25-27.
[19]GUVEN H.TUNCOK Y.GIDENER S,et al.In vitro adsorption of dichlorvos and parathion by activated charcoal[J].Journal of Toxicology Clinical Toxicology.1994,32 (2): 157-163.
[20]BELMOUDEN M,ASSABBANE A,ICHOU Y A.Adsorption characteristics of a phenoxy acetic acid herbicide on activated carbon[J].J Environ Monit.2000,2:257-260
[21]HAMADI N K,SWAMINATHAN S,XIAODONG C.Adsorption of Paraquat dichloride from aqueous solution by activated carbon derived from used tires[J].J Hazard Mater.2004,112(1-2):133-141
[22]IDID S Z,LEE C Y.Effects of Fuller's Earth and activated charcoal on oral absorption of paraquat in rabbits[J].Clin Exp Pharmacol Physiol.1996,23(8):679-681.
[23]张宏顺,孙承业,谢立璟,等.活性炭对急性毒鼠强中毒家兔的疗效研究[J].中华急诊医学杂志.2005,14(3):204-207.
[24]关旭明,任爱琴,李培建.灌服活性碳对有机磷中毒动物血清胆碱脂酶的影响[J].河北医药.2001;23(3):175-176.
[25]周丰美,冯志娟,鲍琴华,等.活性炭胃肠灌洗抢救重症有机磷农药口服中毒患者的临床研究[J].实用护理杂志.2000,16(9):5-6.
[26]刘红,陈淑玲.活性炭吸附联合导泻救治急性有机磷中毒的疗效研究[J].齐鲁护理杂志.2006,12(10):1859-1860.
[27]HOUSTON M,HENDRICKSON R G.Decontamination[J].Crit Care Clin.2005,21(4):653-672
[28]GAUDREAULT P.Activated charcoal revisited[J].Clin Ped Emerg Med.2005,(6):76-80
[29]LAMBERT R J,KINDLER B L,SCHAEFFER D J.The efficacy of superactivated charcoal in treating rats exposed to a lethal oral dose of potassium cyanide[J].Ann Emerg Med.1988,17(6):595-598
[30]SILVA H A,FONSEKA M M,PATHMESWARAN A,et al.Multiple-dose activated charcoal for treatment of yellow oleander poisoning:a single-blind,randomised,placebo-controlled trial[J].Lancet.2003,361:1935-1938
[31]BURTON J R,RYAN C,SHAW-STIFFEL T A.Liver transplantation in mushroom poisoning[J].J Clin Gastroenterol.2002,35(3):276-380.
[32]LAMMINP(A|¨)(A|¨) A,KINOS M.Plant poisonings in children[J].Hum Exp Toxicol.1996,15(3):245-249.