医源性阿片类药物戒断在儿童ICU中的评估研究

目的 对儿童ICU阿片类药物的戒断症状进行评估探索。方法 对连续5 d及5 d以上接受阿片类药物的儿童ICU患儿进行停药后的索菲亚戒断症状量表（Sophia observation withdrawal symptoms scale,SOS）回顾性评分。结果 共86例患儿,年龄中位数为7个月（四分位距5~12月）,研究样本的戒断症状发生率为22%,总疗程中位数9 d（四分位距为6.25~12 d）,SOS ≥ 4患儿的疗程中位数为7 d（四分位距为6~9 d）,骤停易导致戒断症状发生,评估中出现频率最高的症状依次是发烧、呼吸急促、躁动、腹泻、痛哭流泪。结论 儿童ICU患儿存在潜在医源性阿片类药物戒断风险,应重视阿片类药物戒断症状的识别与评估,最大程度地避免戒断症状的发生。     

影响阿片催促戒断反应的实验条件

依赖性研究是药物非临床安全性研究的一部分。依赖性可分为躯体依赖性和精神依赖性2种。躯体依赖性试验包括催促戒断试验(precipitation withdrawal test)和自然戒断试验(natural withdrawal test)。催促戒断试验的基本原理是在短时间内给予动物大剂量受试药,然后注射受体拮抗剂观察和记录是否出现戒断症状及其程度(只适用于阿片类药物)。与同类的代表药物作对比,按照戒断症状的严重程度判断受试药的依赖性潜力。用阿片依赖性大鼠、小鼠进行催促戒断实验是评价阿片类药物躯体依赖性潜力、研究阿片依赖性形成机制和筛选治疗阿片依赖药物的常…     

血清PCT与NLR联合早期预警评分在小儿重症肺炎预后评估中的价值

目的探讨血清降钙素原(PCT)、中性粒细胞与淋巴细胞比值(NLR)联合儿童早期预警评分(PEWS)在小儿重症肺炎预后评估中的临床价值。方法回顾性分析大冶市人民医院儿科2018年1月至2022年6月期间住院治疗的87例重症肺炎患儿病例资料, 根据患儿入院治疗28 d后是否出现死亡分为死亡组和存活组。死亡组22例, 男12例、女10例, 年龄(4.92±1.21)岁;存活组65例, 男37例、女28例, 年龄(4.83±1.12)岁。比较两组重症肺炎患儿性别、年龄、住院时间、病程、基础性疾病、急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分、PCT、PEWS、NLR等, 采用多因素logistic回归法分析影响因素, 绘制受试者工作特征曲线(ROC)分析联合指标的评估价值。统计学方法采用χ2检验、t检验。结果存活组和死亡组在APACHEⅡ评分、PCT、PEWS、NLR等方面差异均有统计学意义(t=6.68、5.93、6.05、6.32, 均P<0.05);APACHEⅡ评分≥21.53分, PCT≥3.42 μg/L, PEWS≥2.24分, NLR≥4.76均为影响重症肺...     

替曲朵辛治疗急性海洛因依赖戒断综合征的随机双盲临床试验

目的:初步评价替曲朵辛(TTX)治疗急性海洛因依赖戒断综合征的疗效和安全性。方法:采用随机双盲、安慰剂对照设计。126例海洛因依赖者随机分为3组,接受疗程为7 d的相应治疗:安慰剂组、5μg TTX和10μg TTX组,bid,肌肉注射;在治疗前及治疗期间每天上午注射给药后1 h采用戒断症状评定量表(OWS)、汉密尔顿焦虑量表(HAMA)和临床总体印象量表(CGI)进行疗效评价,并于治疗前和治疗结束时进行阿片类药物尿检。安全性评价包括在基线和治疗末期进行的实验室检查及每天给药后的生命体征和心电图监测、不良反应报告。结果:3组海洛因依赖者的人口学资料(年龄、性别构成)、海洛因用药特征、基线戒断症状总分和基线焦虑评分没有统计学差异。TTX组的戒断症状评分变化与安慰剂组有显著差异(P<0.05)。3组受试者的焦虑评分在治疗期间逐渐下降,10μg TTX组d4的焦虑评分显著低于安慰剂组(P<0.05)。安慰剂组、5μg TTX组和10μg TTX组分别发生了6例、3例和9例不良事件,严重程度为轻度和中度,各组之间没有显著差异。10μg TTX组的一例受试者因不良事件而停止研究。结论:替曲朵辛注射液每日使用剂量5μg-10μg,疗程7日,对急性海洛因戒断症状的疗效显著优于安慰剂组,且安全性良好。     

儿童重症肺炎机械通气患儿脱机的影响因素分析

目的分析儿童重症肺炎机械通气患儿脱机的影响因素,为临床疾病诊治提供参考。方法 214例重症加强护理病房(ICU)住院并行机械通气治疗的重症肺炎患儿,根据患儿最终脱机结局将所有患儿分为脱机失败组(82例)和脱机成功组(132例)。收集患儿各项基本资料和相关检查结果 ,依次采取单因素分析和多因素Logistic回归分析,确定其成功脱机的影响因素。结果脱机成功患儿132例,成功率为61.68%;脱机失败患儿82例,失败率为38.32%,其中死亡患儿21例,死亡率为9.81%。单因素分析结果得知,脱机成功组患儿年龄(6.95±1.49)岁大于脱机失败组的(4.42±1.51)岁,入院急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分(11.48±4.29)分、D-二聚体含量(1242.32±123.41)μg/L、先天性心脏病占比3.03%均低于脱机失败组的(19.42±4.12)分、(3543.84±172.41)μg/L、13.41%,差异具有统计学意义(P<0.05)。两组患儿的性别、体质量指数(BMI)、白细胞计数(WBC)、中性粒细胞百分比(NEU%)、血红蛋白(Hb)及降钙素原(PCT)水平比较,差异无统计学意义(P>0.05)。Logistic多因素回归分析结果显示,年龄≥6岁、APACHEⅡ评分≥30分、有先天性心脏病、D-二聚体水平≥2000μg/L为儿童重症肺炎机械通气患儿脱机的影响因素(P<0.05),其中以先天性心脏病影响最大。结论年龄≥6岁、APACHEⅡ评分≥30分、有先天性心脏病、D-二聚体水平≥2000μg/L为影响儿童重症肺炎机械通气患儿脱机失败的重要因素,对这些因素积极进行监测和改善治疗可在一定程度上增加机械通气成功脱机率。     

不同镇痛药物方案治疗下肢缺血性疼痛的疗效和安全性分析

目的 对下肢缺血性疼痛患者不同镇痛药物方案的应用情况进行分析,对临床用药提供参考。方法 选取2018年10月1日至2022年10月31日下肢缺血性疼痛住院患者作为研究对象,采用回顾分析法对患者镇痛药物方案进行分析,收集患者基本情况、镇痛药物使用情况、疼痛视觉模拟量表（VAS）评分、不良反应等进行分析。结果 共入组患者71例,按照镇痛方案分阿片类药物组30例、阿片类药物+非甾体抗炎药组（NSAIDs）32例和坐骨神经阻滞组9例。3组患者性别、年龄、病程、合并疾病及吸烟史的比较,差异无统计学意义（P>0.05）;坐骨神经阻滞组VAS评分下降值和阿片类药物组、阿片类药物联合NSAIDs组比较,差异有统计学意义（分别为6.667±1.658 vs 3.567±0.817,t=7.716,P <0.001;6.667±1.658 vs 3.938±0.982,t=6.271,P <0.001）。阿片类药物组和阿片类药物联合NSAIDs组比较,差异无统计学意义（P>0.05)。3组不良反应和安全性比较,差异无统计学意义（P>0.05）。结论 下肢缺血性疼痛镇痛药物方案...     

130例临床药疹分析

目的探讨临床药疹患者的临床特征,如年龄分布、药疹类型及致敏药物种类等,为临床合理用药及预防药疹的发生提供参考。方法回顾性分析130例药疹患者的临床资料,分析药疹患者的临床特征以及影响药疹发生的因素。结果 130例患者男女比例为1︰1.36,平均发病年龄为(31.99±22.24)岁,药疹的发生与发病年龄、性别及潜伏期无关,与药物种类相关。重症药疹组发病率最高的是解热镇痛类药物(30.77%),非重症药疹组发病率最高的是抗生素类药物(46.15%)。结论药疹的发生与发病年龄、性别及潜伏期无关,与药物种类相关。重症药疹组发病率最高的是解热镇痛类药物,非重症药疹组发病率最高的是抗生素类药物。     

异喹啉类生物碱对海洛因依赖大鼠的戒断症状和一氧化氮及一氧化氮合酶的影响

目的:采用海洛因依赖大鼠模型,探讨异喹啉类生物碱(HBA)对阿片类药物依赖性的防治作用及作用机制。方法:实验分为正常组、模型组、低剂量HBA组、中剂量HBA组、高剂量HBA组和可乐定组。除正常组外均皮下注射海洛因,复制海洛因依赖模型。在复制模型的同时给药,末次给药后用纳洛酮催促,观察大鼠戒断症状和体重变化,测定大鼠中枢神经系统中一氧化氮(NO)含量和一氧化氮合酶(NOS)活力。结果:实验结果表明,与模型组相比,给药组大鼠的戒断症状和体重丧失显著减轻(P<0.05,0.01),与模型组相比,给药组大鼠大脑、脑干、脊髓中的NO含量明显升高(P<0.05,0.01),脑干和脊髓中NOS活力增高(P<0.05,0.01)。结论:HBA可减轻海洛因依赖大鼠的戒断症状,HBA拮抗阿片类药物依赖的作用,可能与阿片受体、中枢神经系统中NO的表达机制有关。     

强阿片药物对阿片耐受的晚期癌症患者肝功能的影响

目的观察阿片耐受患者用药前后肝功能水平的变化,探讨长期应用强阿片类药物对患者肝功能的影响。方法搜集我院52例联合或单独使用吗啡、羟考酮、芬太尼超过30 d的晚期癌症患者,进行疼痛治疗情况分析,并比较用药前后血清肝功能水平。结果晚期癌症患者在使用耐受剂量强阿片类药后1周、2周及1个月肝功能无显著变化(P>0.05),在患者病程终末期谷草转氨酶、直接胆红素、间接胆红素水平与用药初期相比,差异有统计学意义(P<0.05)。结论规范合理使用强阿片类药物初期不会导致肝损伤,长期应用应监测患者肝功能水平;对于癌症患者进行规范化癌痛治疗,可确保存在肝损伤风险的患者在使用强阿片类药物后,不会显著增加肝损伤的风险。     

艾迪注射液联合芬太尼透皮贴治疗难治性癌痛10例

目的观察艾迪注射液联合芬太尼透皮贴治疗难治性癌痛的效果。方法20例晚期肝癌伴癌痛患者被随机分为单药组和联合组,每组10例,患者均对硫酸吗啡缓释片不耐受或效果不佳。两组均于治疗开始每72 h更换芬太尼透皮贴4.2 mg(25μg/h)1张,联合组每日加用艾迪注射液100 mL静脉滴注,以盐酸吗啡注射液皮下注射治疗爆发痛。用数字疼痛评估法(NRS)记录疼痛评分,根据前24 h阿片类药物总量计算增加芬太尼透皮贴剂量,以疼痛明显缓解或完全缓解为治疗目标;连续观察14 d,评价两组患者疼痛缓解率、疼痛评分、芬太尼透皮贴使用剂量、中医症状积分、不良反应。结果两组治疗后的各级癌痛缓解率、疼痛评分及不良反应发生率均无显著性差异(P>0.05);芬太尼透皮贴平均使用剂量分别为单药组(90.00±35.75)μg/h、联合组(60.00±21.08)μg/h(P<0.05);中医症状积分分别为单药组(11.10±1.85)分,联合组(9.30±1.34)分(P<0.05)。结论芬太尼透皮贴能有效治疗难治性癌痛,艾迪注射液能在一定程度上减少芬太尼透皮贴治疗肝癌伴癌痛的剂量。两者联用,进一步改善临床症状。     

Opioid and Benzodiazepine Weaning in Pediatric Patients: Review of Current Literature

Pediatric opioid and benzodiazepine withdrawal are avoidable complications of pain and sedation management that is well described in the literature. To prevent withdrawal from occurring, practitioners regularly use a steady decrease of pain and sedation medications, also known as a weaning or tapering schedule. The weaning schedule is highly variable based on clinician preference and is usually dependent on the clinician. The purposes of this review are to evaluate the current literature on the process of opioid and benzodiazepine weaning in pediatric patients and to assess the various standardized protocols used to decrease withdrawal occurrences. We conducted a search of the PubMed, MEDLINE, Cochrane Library, Cumulative Index of Nursing and Allied Health (CINAHL), Academic Search Premier, and PsycInfo databases. Studies were included if they described a wean or taper in pediatric patients aged 18 years or younger. Studies describing neonatal abstinence syndrome were excluded from the review. A total of 97 studies published between 2000 and 2014 were retrieved; of those, 15 studies met the inclusion criteria. Studies were evaluated for selection of withdrawal assessment tool, wean protocol summary, preferred weaning agents, benzodiazepine withdrawal, and wean‐at‐home regimen. The most common opioid‐weaning protocol approaches described a 10–20% dose decrease per day. Benzodiazepine weaning was not regularly standardized or described. The use of a standardized opioid‐weaning protocol reduced withdrawal rates compared with nonstandardized weaning plans. Benzodiazepine weaning was inconsistently evaluated and may have affected study outcomes. Identified areas of improvement include the use of newer withdrawal assessment tools validated in the older pediatric population and standardized withdrawal assessment and reporting.     

两性霉素B脂质体致急性肾损伤相关危险因素分析

目的统计分析两性霉素B脂质体致急性肾损伤(AKI)的发生率及相关危险因素。方法回顾性分析某三甲医院2016年1月—2018年12月使用两性霉素B脂质体患者的病历资料,记录患者基本资料和相关用药情况,采用单因素与多因素逐步logistic回归分析两性霉素B脂质体相关AKI危险因素。结果272例使用两性霉素B脂质体的患者,24例发生两性霉素B脂质体相关AKI,发生率8.8%;单因素分析显示,女性、联用环孢素、造血干细胞移植和两性霉素B脂质体累计使用量≥450 mg与AKI发生有关(P<0.1);多因素分析显示,女性和两性霉素B脂质体累计使用量≥450 mg是AKI独立危险因素(P<0.05);13例发生AKI患者停药1周后肌酐值较用药期间最高值下降(P<0.05)。结论两性霉素B脂质体致AKI较常见,用药期间应加强女性患者及累计使用剂量≥450 mg患者发生AKI的风险评估,密切监测给药期间尤其是约2周患者肌酐水平。大部分患者AKI可逆。     

Use of methadone for prevention of opioid withdrawal in critically ill children

Background

Opioids are commonly administered to critically ill children for analgesia and sedation, but many patients experience opioid withdrawal upon discontinuation. The authors’ institution developed a protocol for using methadone to prevent opioid withdrawal in children who have received morphine by continuous IV infusion for 5 days or longer in the pediatric intensive care unit (PICU).

Objectives

The primary objectives were to determine if opioids were tapered according to the protocol and to determine the conversion ratio for IV morphine to oral methadone that was used. Secondary objectives were to describe the methadone dosage used and the clinical outcomes, to evaluate adjustments to methadone dosing, and to report the incidence of adverse effects.

Methods

A retrospective analysis of charts was conducted for pediatric patients who had received morphine by continuous IV infusion for 5 days or longer followed by methadone in the PICU between May 2008 and August 2009. Validated scoring systems (the Withdrawal Assessment Tool and the State Behavioral Scale) were used to assess symptoms of withdrawal and degree of sedation, respectively.

Results

Forty-three patients were included in the study, with median age of 8 months (range 0.25–201 months). For 31 patients (72%), the protocol was not used, and there were no patients for whom the protocol was followed to completion. The median duration of weaning was 10 days (range 0–91 days). The conversion ratio for IV morphine to oral methadone was 1:0.78 for anticipated 5-day weaning and 1:0.98 for anticipated 10-day weaning. During the first 10 days of weaning, 18 patients (42%) experienced withdrawal symptoms. The methadone dose was increased for 11 (26%) of the 43 patients. Patients were sedated for a median of 1 day (range 0–9 days), were comfortable for a median of 6.5 days (range 1–64 days), and were agitated for a median of 2.5 days (range 0–23 days). Naloxone was required for 2 patients.

Conclusions

The institution’s methadone protocol was not followed consistently during the study period, and practices for transitioning from morphine by continuous IV infusion to methadone with tapering were also inconsistent. Further studies are needed to determine the optimal conversion ratio for morphine to methadone and the optimal tapering regimen to minimize withdrawal symptoms and adverse events.     

小儿先天性心脏病术后感染相关因素分析

目的：分析小儿先天性心脏病术后感染的相关因素,为临床用药、护理及治疗提供依据。方法：对2008年9月～2009年5月期间,进行先天性心脏病手术、满足入选条件的患儿346人,进行回顾性分析,根据发生感染与否将患儿分为感染组（39人）和对照组（307人）;将可能的危险因素先进行单因素分析,在此基础上进行多因素Logisitic回归分析。结果：两组患儿在年龄、术前住院时间、体重等17个指标上的差异有统计学意义（P〈0．05）;多因素Logisitic回归分析表明肺动脉高压、恢复室停留≥120h、体外循环时间≥120min、机械通气时间≥120h、频繁的吸痰是发生感染的独立危险因素。结论：多种因素导致先心病患儿术后发生感染,必须采取综合性的预防措施才能有效控制。     

Availability of Reliable Serum Methadone Determination for Management of Symptomatic Patients

Methadone, when used in the appropriate dose, prevents opioid withdrawal during the 24-hour period following medication. However, the appropriate dose for a given patient may be difficult to determine due to variations in methadone metabolism which is affected by many factors. Early opioid withdrawal, requiring a higher dose of methadone, is often difficult to diagnose because many of the symptoms are also symptoms of other syndromes common in the methadone maintenance population. In this study, ten patients in stable methadone maintenance treatment reporting ≥ 4 Himmelsbach signs of abstinence were compared with ten patients reporting fewer symptoms. Until recently, accurate, precise, and affordable determination of serum methadoe level has not been readily available from commercial laboratories. This study has found that such measures are now available. Serum specimens from each subject were sent to three commercial laboratories for determination of serum methadone level. Results from the three laboratories were highly correlated. No statistical correlation was found between serum methadone level and number of Himmelsbach signs. Of the subjects reporting four or more symptoms, 40% had low serum methadone levels (< 150 ng/ml); 60% did not. Of the subjects reporting fewer than four symptoms, 90% had serum methadone levels ≥ 150 ng/ml. Subjects with ≥ 4 Himmelsbach signs had lower dose-adjusted serum methadone levels, the amount of methadone circulating per mg dose, (t = 1.54, p = .0702). Thus, for patients who report symptoms which could be attributable to opioid withdrawal, measurement of serum methadone level may help to differentiate complaints due to early abstinence from those due to other medical conditions.     

小儿癫痫停用抗癫痫药物后复发的高危因素分析

目的：研究小儿癫痫停用抗癫痫药物后复发的高危因素，为小儿癫痫复发的控制提供理论依据。方法：本研究观察对象为2013年1月至2017年1月于我院诊治的176例小儿癫痫患者，均达到病情完全控制后停药，随访1年记录复发病例，将复发病例设为观察组，未复发者设为对照组，调查两组患儿性别、年龄、发病年龄等病历资料，采用单因素与logistic回归分析方法分析儿癫痫停用抗癫痫药物后复发的独立危险因素。结果：176例患者停药1年内复发60例，复发率34.09%，平均复发时间（5.54±1.21）月；单因素分析显示两组发病年龄、发病频率、停药时机、停药后脑电图（EGG）、发作类型、颅内病灶比较差异有统计学意义（P<0.05），两组性别、用药种类比较差异无统计学意义（P>0.05）；多因素logistic回归分析结果显示，发病年龄<2岁[OR=3.211，95%CI（0.876~10.546）]、停药后EGG痫性放电[OR=2.678，95%CI（0.971~9.211）]、停药前无发作时间<4年[OR=2.213，95%CI（0.654~8.321）]、局灶性发病[OR=2.034，95%CI（0.653~9.768）]、发作频率>5次/年[OR=2.446，95%CI（0.542~8.419）]是小儿癫痫停用抗癫痫药物后复发的独立危险因素。结论：小儿癫痫停用抗癫痫药物后复发较高，发病年龄<2岁、停药后EGG痫性放电、停药前无发作时间<4年、局灶性发病、发作频率>5次/年均会增加复发风险，应根据危险因素采取针对性干预措施。     

Comparison of tincture of opium and methadone to control opioid withdrawal in a Thai treatment centre

AIMS: To evaluate the effectiveness of oral tincture of opium (TOP) and methadone to control opioid withdrawal in patients in northern Thailand. METHODS: Open label, parallel group study in an inpatient facility compared 15 former heroin users receiving methadone 5-20 mg 12 hourly with 15 former opium smokers receiving TOP (3.33-10 mg morphine equivalents 12 hourly). At 0, 1, 3 and 8 h, blood, withdrawal scores and subjective opioid effects were collected. RESULTS: There was a reciprocal association between withdrawal scores/direct subjective opioid effects and plasma (R)-methadone, but not plasma morphine, concentrations. Withdrawal scores at the time of dosing were higher in the TOP patients (9.1 +/- 3) than in the methadone patients (4.5 +/- 4.6) and in the TOP patients were significantly (P = 0.001) attenuated at 3 and 8 h. CONCLUSIONS: At the doses used, TOP was inferior to methadone in suppressing withdrawal. It could prove to be a cost effective and valuable drug, but only after dose size and frequency are further investigated.     

Predictors of outcome for short-term medically supervised opioid withdrawal during a randomized, multicenter trial of buprenorphine-naloxone and clonidine in the NIDA clinical trials network drug and alcohol dependence

Few studies in community settings have evaluated predictors, mediators, and moderators of treatment success for medically supervised opioid withdrawal treatment. This report presents new findings about these factors from a study of 344 opioid-dependent men and women prospectively randomized to either buprenorphine-naloxone or clonidine in an open-label 13-day medically supervised withdrawal study. Subjects were either inpatient or outpatient in community treatment settings; however not randomized by treatment setting. Medication type (buprenorphine-naloxone versus clonidine) was the single best predictor of treatment retention and treatment success, regardless of treatment setting. Compared to the outpatient setting, the inpatient setting was associated with higher abstinence rates but similar retention rates when adjusting for medication type. Early opioid withdrawal severity mediated the relationship between medication type and treatment outcome with buprenorphine-naloxone being superior to clonidine at relieving early withdrawal symptoms. Inpatient subjects on clonidine with lower withdrawal scores at baseline did better than those with higher withdrawal scores; inpatient subjects receiving buprenorphine-naloxone did better with higher withdrawal scores at baseline than those with lower withdrawal scores. No relationship was found between treatment outcome and age, gender, race, education, employment, marital status, legal problems, baseline depression, or length/severity of drug use. Tobacco use was associated with worse opioid treatment outcomes. Severe baseline anxiety symptoms doubled treatment success. Medication type (buprenorphine-naloxone) was the most important predictor of positive outcome; however the paper also considers other clinical and policy implications of other results, including that inpatient setting predicted better outcomes and moderated medication outcomes.     

Naltrexone shortened opioid detoxification with buprenorphine.

This double-blind, randomized, placebo-controlled clinical trial evaluated the impact on withdrawal symptoms of (i) combining naltrexone with a 4-day buprenorphine taper for short opioid detoxification (NB Group), compared to (ii) using a 4-day buprenorphine taper alone, followed by naltrexone on day 8 (PB Group). Sublingual buprenorphine was administered on days 1-4 (26 mg total). For the NB Group (n = 32) escalating doses of oral naltrexone were given on days 2-8 (placebo day 1). For the PB Group (n = 28) placebo was given on days 1-7 and naltrexone on day 8. Main outcome measures were Observed Opioid Withdrawal scores (OOW, 0-30) and use of medications to treat opioid withdrawal. Of 32 patients in the NB group, 59% experienced clinically relevant withdrawal (defined as OOW > or = 5) on day 2, but, after day 5, none experienced withdrawal. In the PB group, the number of patients experiencing withdrawal increased over time. The first naltrexone dose induced comparable withdrawal in both groups: peak OOW scores were (mean +/- SD) 5.2 +/- 3.3 on day 2 for the NB group, and 4.0 +/- 3.9 on day 8 for the PB group (NS), though, on day 2, 7 patients dropped out in the NB group and none in the PB group, while only one patient dropped out in the PB group on day 8. Throughout the 8-day study, patients in both groups received similar amount of adjunct medication: 0.64 +/- 0.07 mg (NB group) of clonidine vs 0.73 +/- 0.15 mg (PB group; NS). Only 25% of patients required use of sedatives (up to 20 mg diazepam). Starting naltrexone on day 2 appeared to abolish withdrawal symptoms after day 5 and, thus, to shorten the duration of withdrawal symptoms. Peak withdrawal symptoms after naltrexone were of moderate intensity, suggesting that naltrexone combined with buprenorphine is an acceptable and safe treatment for shortened opioid detoxification and induction of naltrexone maintenance.     

高龄肺癌围手术期呼吸并发症的相关因素研究

目的探究高龄肺癌围手术期呼吸并发症的相关危险因素,探讨其对肺癌手术安全性的预测价值,以指导临床高龄肺癌患者的围手术期治疗。方法随机选取我院在2006年3月至2010年8月接受肺癌手术治疗的老年肺癌患者共60例进行回顾性分析,对其术后呼吸并发症进行统计,并于可能与术后并发症相关的因素进行单因素和多因素logistic回归分析。结果本研究患者共28例出现呼吸系统并发症,3人死亡,单因素和多因素分析结果显示年龄≥70岁、合并重要器官基础疾病、全肺切除、FEV1/FVC<70%、吸烟指数≥400支/年肺癌患者手术围术期发生呼吸系统并发症的危险因素。结论对高龄肺癌患者术前评估以上相关危险因素,可初步预测患者呼吸系统并发症发生情况,对患者围手术期的治疗有重要临床指导意义。