海洛因依赖者脱毒治疗中产生谵妄的临床分析

目的··：探讨海洛因依赖者于脱毒治疗中生产谵妄的影响因素。方法··：总结１９９３年８月至１９９６年８月间首次入我院接受脱毒治疗的１２３例海洛因依赖者的有关资料，并对不同情况下发生谵妄进行比较。结果··：共有５６例产生谵妄，谵妄发生率为４５．５％，以注射方式滥用毒品、健康状况较差的患者谵妄发生率明显高于其他方式滥用者（Ｐ＜０．０１），而使用美沙酮替代方式脱毒较之丁丙诺啡，谵妄发生率明显低（Ｐ＜０．０１）。结论··：海洛因戒断、精神药物的使用、躯体疾患是导致谵妄产生的主要影响因素。     

安定身体依赖性小鼠脑内单胺类递质的研究

本研究以掺食法递增安定剂量，喂食５６ｄ，形成身体依赖性模型，观察对小鼠自主运动的影响。戒断后小鼠自主活动增加，２４ｈ时戒断组自主流动显著高于对照组（Ｐ＜０．０１），并测定戒断后小鼠脑内单胺类递质水平，去早肾上腺素（ＮＥ）变化不明显；多巴胺（ＤＡ）在戒断后２４ｈ达２．３５ｕｇ·ｇ－１±ｓ０．４０ｕｇ·ｇ－１脑组织，明显高于喂食安定７ｄ组（１．９３ｕｇ·ｇ－１±ｓ０．２５ｕｇ·ｇ－１）（Ｐ＜０．０５）．５－羟色胺（５—ＨＴ）下降．至２４ｈ时达最低点，而其代谢物５－羟吲哚乙酸（５－ＨＩＡＡ）则升高，与５－ＨＴ变化呈负相关（ｒ＝－０７８８０）     

氯胺酮麻醉对红细胞免疫功能的影响及左旋咪唑的调节作用

目的 研究氯胺酮麻醉对机体红细胞免疫机能的影响及左旋咪唑对免疫机能的作用。方法 １６只家兔随机分成两组，对照组（１组）和左旋咪唑组（２组）。所有家兔肌肉注射氯受酮２４ｍｇ·ｋｇ－１麻醉，２组同时肌肉注射左旋咪唑５ｍｇ·ｋｇ－１。注药后１５ｍｉｎ折断左臂骨。分别于麻醉前、注药后５ｈ、１ｄ、２ｄ、３ｄ、４ｄ从耳缘静脉取血，肝素抗凝，测定红细胞免疫粘连功能。结果 氯胺酮麻醉后１组ＲＢＣ－Ｃ３ｂ受体酵母菌花环形成率在各时机均下降（Ｐ＜０．０１）；２组仅在麻醉后１ｄ显著降低（Ｐ＜０．０５）；两组在各同一时相比，２组均较１组升高（Ｐ＜０．０５或Ｐ＜０．０１）。ＲＢＣ－ＩＣ酵母菌花环形成率１组在注药后５ｈ显著高（Ｐ＜０．０１），而２组在各时相无显著变化。结论 氯胺酮麻醉后红细胞免疫功能明显降低，左旋咪唑可明显改善氯胺酮麻醉后红细胞免疫粘连功能。［     

海洛因依赖者T细胞亚群阳性率研究

本文应用ＣＤ２、ＣＤ４、ＣＤ８单克隆抗体通过ＡＰＡＡＰ桥联酶标技术检测了３９例海洛因依赖者Ｔ细胞阳性率的变化，结果表明：海洛因滥用者平均Ｔ细胞阳性率（ＣＤ４５３．２±ｓ１０．９）比健康人（６２．０±ｓ７．１）为低（Ｐ＜０．０１），ＣＤ４／ＣＤ８比值也比健康人降低（Ｐ＜０．０５），ＣＤ２、ＣＤ８无明显改变；不同滥用者经住院治疗８－１２ｄ后，抽血测定Ｔ细胞阳性率，ＣＤ２为８２．５±ｓ６．８，较脱毒治疗前为低（Ｐ＜０．０１）。ＣＤ４、ＣＤ８及ＣＤ４／ＣＤ８无明显改变。Ｔ细胞阳性率在男女性别之间，吸海洛因与褴用度冷丁、黄皮、二氢埃托啡之间，烫吸与注射比较，吸毒量＜１．０ｇ·ｄ－１与吸毒量＞１．０ｇ·ｄ－１，吸毒时间（＞１８月）与吸毒时间短（＜１８月）比较，Ｔ细胞阳性率均无明显差别。     

盐酸纳曲酮用于阿片类依赖者脱毒后预防复发的效能研究

采用开放与双盲试验的多中心性随访观察，对于３０２例海洛因依赖者脱毒治疗后服用纳曲酮进行的为期６个月观察，就纳曲酮对阿片类依赖者预防复吸的效能进行了研究。双盲组纳曲酮的服用剂量为５０ｍｇ·ｄ－１，开放试验的药物剂量随用药者的反应进行调整。双盲试验中，纳曲酮组和安慰剂组第６个月的保持率分别为２８．５７％和７．１４％。开放组第６个月的纳曲酮保持率及平均保持时间分别为２３．６％和３．１６月，而该组人群既往脱毒后第６个月的操守率及平均操守时间分别为１．２％和０．５个月。双盲试验中服用纳曲酮组再吸海洛因后无舒适体验者占６８．１８％，安慰剂组为３３．３％；纳曲酮组尿吗啡检测阳性率（２４．３８％）低于安慰剂组（４０．４８％）。服药后出现的反应包括睡眠障碍、焦虑、食欲减退、无力、易激惹、腹痛和骨肌肉痛、发冷、恶心呕吐、紧张、腹泻、头晕、头痛、便秘和皮疹。这些症状中包括纳曲酮促发的稽延性戒断症状。少部分受试者出现肝脏功能异常及心电图异常。为达到充分阻断海洛因的作用，服用剂量以４０－５０ｍｇ·ｄ－１为宜。本研究显示，纳曲酮对阿片类依赖者脱毒后预防复吸有一定的辅助作用，药物毒副作用较小，适于长期服用。     

50例海洛因依赖者脱毒治疗前后抑郁和焦虑状况分析

本文采用抑郁自评量表（ＳＤＳ）和焦虑自评量表（ＳＡＳ）对５０例海洛因依赖者脱毒治疗前后进行测评,结果显示其脱毒前后的ＳＤＳ和ＳＡＳ总体评分非常显著地高于全国常规（Ｐ＜０．０１）,疗后虽有显著下降（Ｐ＜０．０５）,但仍高于常规（Ｐ＜０．０１）,烫吸组、滥用年限≤２年组和日滥用量＜１ｇ组的疗后ＳＤＳ评分均低于疗前（Ｐ＜０．０５）,日滥用量＜１ｇ组的疗后ＳＡＳ评分还低于疗前（Ｐ＜０．０５）;注射组疗前ＳＤＳ评分高于烫吸组,日滥用量≥１ｇ组的疗前后ＳＡＳ和疗后ＳＤＳ评分显著高于日滥用量＜１ｇ组（Ｐ＜０．０５～０．０１）。说明海洛因依赖者脱毒治疗前后均存在严重的情绪障碍,并与日滥用量、滥用年限和滥用方式有一定关系。作者认为为期１０天的住院脱毒期过于短暂,必须延长,接受心理康复、行为康复和社会技能训练,只有在情绪已趋正常的前提下方可让海洛因依赖者离院     

小儿肺部疾患时超氧化物歧化酶及丙二酶的改变

我科自１９９３年７月－１９９４年１月的住院病人中，选择肺部疾患患儿５２例（包括肺炎３２例，喘息性支气管炎１１例，支气管哮喘９例），测定红细胞超氧化物歧化酶（ＳＯＤ）活性和血浆丙二醛（ＭＤＡ）的含量。结果表明在患病极期ＳＯＤ活性校对照组明显下降（Ｐ＜０．０１）；ＭＤＡ的含量较对照组明显升高（Ｐ＜０．０１）。在３２例肺炎患儿中ＳＯＤ活性与对照组比较有所下降（０．０１＜Ｐ＜０．０５）；ＭＤＡ含量较对照组比较明显升高（Ｐ＜０．０１）。说明氧自由基（ＯＦＲ）与小儿肺部疾患有密切关系，并参与了该病的病理过程。     

小剂量纳曲酮结合行为心理干预和家庭介入防复吸效果

目的··:探讨小剂量纳曲酮与心理行为干预 ,家庭介入相结合防止海洛因依赖者脱毒后复吸效果。方法·· :纳曲酮日用量 ,注射方式滥用者第1 -2月30mg,3 -4月20mg,5 -6月15mg,烫吸者第1 -2月20mg,3 -6月15mg,同时辅以心理行为干预及家庭介入相应措施 ,6个月为一疗程。结果·· :170例受试者6个月纳曲酮治疗保持率为27.1% (46例 ) ,戒断操守率为43.5 % (74例 )。结论··:此方案可以提高纳曲酮治疗接受率 ,降低纳曲酮胃肠道反应和对肝的毒性 ,减轻患者家庭经济负担。其治疗效果与足量纳曲酮效果相当     

人体中氧氟沙星的立体选择性代谢

５名健康志愿者日服单剂３００ｍｇ氧氟沙星［（±）－Ｏｆ１］后，采用立体选择性的ＲＰ－ＨＰＬＣ手性流动相添加剂法测定尿中Ｓ－（－）－Ｏｆ１和Ｒ－（＋）－Ｏｆ１浓度结果显示Ｏｆ１在人体内呈现立体选择性代谢。尿中排泄的Ｓ－（－）－Ｏｆ１／Ｒ－（＋）－Ｏｆ１之比随时间变化。服药后２ｈＳ／Ｒ是０．８７５，２４ｈ增加到１．１５０．Ｓ－（－）－Ｏｆ１的消除半衰期（ｔ１／２）是４．５７ｈ；消除速率常数（ｋ）是０．１５４ｈ；药时曲线下的面积（ＡＵＣ）为１．１７ｍｇ·ｈ－１．ｍＬ－１；Ｒ－（＋）－Ｏｆ１的ｔ１／２为４．１８ｈ，ｋ为０．１６８ｈ－１，ＡＵＣ是１．７８ｍｇ·ｈ－１·ｍＬ－１；经配对ｔ检验这三对参数间有显著性差异，Ｐ值分别小于０．０１，０．００１和０．００５．因此两对映体在人体内呈现立体选择性处置     

牛磺酸对阿霉素致膈肌毒性的保护作用

目的研究牛磺酸对阿霉素致隔肌毒性的保护作用。方法家兔１８只,分３组：①对照组：静脉注射生理盐水（ＮＳ）×５ ｄ;②ＮＳ＋阿霉素组：静脉注射ＮＳ×５ ｄ;③牛磺酸＋阿霉素组：静脉注射牛磺酸 １００ ｍｇ·ｋｇ－１ × ５ ｄ。 ２、３组于末次注射后 ２ ｈ,静脉注射阿霉素 １０ ｍｇ·ｋｇ－１组注射等量ＮＳ。２４ｈ后,麻醉动物,测量跨膈压（Ｐｄｉ）、膈肌诱发电位（ＤＥＰ）。同时测定膈肌组织中丙二醛（ＭＤＡ）含量和超氧化物歧化酶（ＲＪＤ活性。电镜观察细胞器改变。结果阿霉素（ １０ ｍｇ· ｋｇ－１）可使跨膈压（ Ｐｄｉ）、膈肌诱发电位（ＤＥＰ）幅度降低（ Ｐ＜ ０． ０５）;膈肌中 ＭＤＡ含量增加, ＳＪＤ活性降低（Ｐ＜０．０５）,肌小节和线粒体形态改变。而牛磺酸１００ｍｇｋｇ－１可抑制上述现象。结论牛磺酸对阿霉素致膈肌毒性有保护作用。     

Opiate detoxification under anesthesia: no apparent benefit but suppression of thyroid hormones and risk of pulmonary and renal failure

INTRODUCTION: The new technique for opiate detoxification using anesthesia and high, repetitive doses of opiate-antagonists claims to detoxify addicts without withdrawal symptoms within 24-48 hours. We studied the method with 12 opiate addicts (5 L-polamidone, 4 dihydrocodeine, 3 heroin), using general anesthesia and the antagonists naloxone 0.5 mg/kg and naltrexone > 150 mg. Objective and subjective withdrawal symptoms were measured until urine was free of drugs and patients had no withdrawal symptoms. Thyroid hormones were measured before, during, and after the anesthesia period. RESULTS: All patients had moderate to severe opiate withdrawal symptoms. No detoxification was finished within 48 hours. The dihydrocodeine subjects were compared with conventionally detoxified controls; no difference was seen. The method suppressed thyroid hormones TT3, TT4, and TSH. The study was terminated because of side effects: 1 pulmonary failure and 2 renal failures. All patients survived without sequelae. CONCLUSION: There is no obvious benefit from this method, whereas the risks are high.     

参附脱毒胶囊联合美沙酮脱毒的疗效观察

目的:评价应用中西医结合对海洛因脱毒的疗效与不良反应。方法:将180例海洛因依赖者按入院时间先后顺序随机分为A、B两组,A组给与美沙酮口服液加参附脱毒胶囊,B组单用美沙酮,对照观察两组的疗效和不良反应。结果:在控制戒断症状方面,治疗早期,A组与B组比较无显著性差异(P﹥0.05),d4起两组比较有显著性差异(P﹤0.05),尤其在焦虑、寒战、骨骼肌肉痛、厌食、失眠、恶心呕吐记分差异有显著性或非常显著意义(P﹤0.05或P﹤0.01)。药物不良反应发生率较低。结论:美沙酮联合人参附子脱毒胶囊脱毒治疗,疗效可靠,特别利于控制后期稽延性戒断症状。药物不良反应少。     

全麻下超快速脱毒复合洛菲西定治疗海洛因依赖

目的探讨全麻下超快速脱毒(UROD)复合洛菲西定治疗海洛因依赖的效果。方法选择60例海洛因依赖者,随机分成两组。对照组行常规UROD,试验组在此基础上,术前晚口服洛菲西定0.4mg,术中再给予1.6mg。对两组病人围术期腹泻,丙泊酚用量及戒断症状评分进行评估。结果与对照组相比,试验组的丙泊酚用量(P<0.001),术后24h内腹泻的发生率(P<0.01),术后24h时主观戒断症状的评分(P<0.001)和客观戒断症状评分(P<0.05)的差异均有显著性。结论UROD复合洛菲西定用于海洛因依赖者脱毒,可以明显减轻戒断症状并降低费用,值得推广。     

海洛因依赖者自然戒断过程中血压、心率的变化及心理状况

目的·· :了解海洛因依赖者自然戒断(冷火鸡)过程中血压、心率的动态变化及心理健康状况。方法·· :测定海洛因依赖者自然戒断d1 -15的收缩压、舒张压和心率 ,并完成d1、d10和d30症状自评量表(SCL -90)评定。结果··:海洛因依赖者收缩压在自然戒断的d2 -15均低于对照组(P<0.05或P<0.01) ,仅d1与对照组无显著性差异。舒张压在自然戒断的d2 -12和d15都低于对照组(P<0.05或P<0.01) ,d1、d13和d14与对照组无显著性差异。心率在自然戒断的d1 -15均高于对照组(P<0.05或P<0.01)。SCL -90评定显示 ,海洛因依赖者阳性项目数、躯体化、焦虑、精神病性分在自然戒断的d1、d10、d30均高于国人常模(P<0.05或P<0.01) ;抑郁、敌对、恐怖分在戒断的d1高于国人常模(P<0.05或P<0.01) ,而在自然戒断的d10、d30与常模比较无显著性差异。在不同时间内因子分除躯体化外 ,均以焦虑分值较高 ,显示海洛因依赖者在自然戒断过程中的心理问题以焦虑最为突出。自然戒断的d1、d10、d30单一症状≥3分的项目基本相同 ,主要是忘性大、腰痛、难以入睡、醒得太早、睡得不深不稳。结论··:海洛因依赖者自然戒断过程中血压主要表现为降低 ,而心率有不同程度的加快 ,心理问题以焦虑最为突出     

电针背俞穴治疗海洛因患者早期稽延性戒断症状的临床研究

目的:比较电针背俞穴、五输穴对改善海洛因患者早期稽延性戒断症状的临床疗效,为优化配穴组方,提高电针戒毒的临床疗效提供依据。方法:将27例海洛因依赖者随机分成3组,采用海洛因稽延症状评定量表,动态观察不同的针灸配穴对早期稽延性戒断症状的治疗效果。结果:电针背俞穴组和电针五输穴组都能明显降低治疗第一天、第二天的稽延症状总评分(p<0.01),都不能降低治疗第一天、第二天的睡眠症状评分(p>0.01)。电针背俞穴组能明显改善患者的焦虑情绪(p<0.01),而电针五输穴组对焦虑情绪则无明显影响,两者表现出明显的差别。结论:电针背俞穴能明显改善稽延症状总评分。与传统五输穴配穴相比,电针背俞穴能明显改善患者的焦虑情绪。     

Antagonist-precipitated heroin withdrawal under anaesthetic prior to maintenance naltrexone treatment: determinants of withdrawal severity

This study sought to characterize antagonist-precipitated heroin withdrawal during and immediately following anaesthesia and to identify the determinants of withdrawal severity and duration in 48 dependent heroin users. Objective withdrawal signs decreased significantly with each naloxone bolus administered under anaesthetic. The cost (amount) of the final heroin administration and the number of hours between last heroin use and commencement of anaesthesia were significant, independent predictors of the severity of withdrawal symptomatology. While 83% (40/48) of participants completed withdrawal according to objective criteria and commenced maintenance naltrexone treatment, almost half (22/48) were unable to commence naltrexone on the day of the procedure due to residual withdrawal signs. Fourteen of these 22 participants subsequently commenced naltrexone (median number of days between admission and commencement of naltrexone was 2, range 1 - 6) while eight left treatment prior to initiation of naltrexone. Significantly fewer of those with more severe withdrawal signs during anaesthesia commenced naltrexone (40% vs. 60%). While the severity and duration of withdrawal symptomatology may be moderated by encouraging participants to reduce (or cease) heroin use close to the time of withdrawal, for a substantial proportion of participants in this study, heroin withdrawal by this antagonist-precipitated procedure was neither rapid nor painless. [Ali R, Thomas P, White J, McGregor C, Danz,C, Gowing L, Stegink A, Athanasos P. Antagonist-precipitated heroin withdrawal under anaesthetic prior to maintenance naltrexone treatment: determinants of withdrawal severity. Drug Alcohol Rev 2003;22:425 - 431]     

Rapid opiate detoxication in outpatient treatment: relationship with naltrexone compliance

A variety of detoxification methods have been utilized for the treatment of heroin withdrawal before individuals begin long-term opiate-free and naltrexone programs. While methadone in decreasing doses is still widely used for detoxication procedures, rapid and ultrarapid protocols including clonidine and opiate receptors antagonists have been proposed. This study compares the efficacy of different detoxification methods and investigates possible changes in naltrexone compliance. Ninety-eight heroin-addicted individuals were studied to evaluate withdrawal symptoms, craving, mood, urine toxicologic screens, and drop-out rate during therapy with: Group A: clonidine only (5 days); Group B: clonidine, oxazepam, baclofen, and ketoprofene with naloxone and naltrexone (2 days); and Group C: methadone in decreasing doses (10 days). Naltrexone compliance and relapse rates were evaluated during a 6-month follow-up period. Rapid detoxification with opiate antagonists (Group B) induced slight and transient withdrawal symptoms, and resulted in a significantly lower percentage of heroin catabolites in urine controls during the detoxification procedure, lower negative and positive craving, less mood problems, and higher compliance in extended naltrexone treatment. In comparison with clonidine only (Group A) and methadone (Group C), the early use of naltrexone during detoxification in combination with benzodiazepines and clonidine facilitated extended naltrexone acceptance and improved the recovery outcome in outpatients.     

海洛因依赖者戒断时睡眠障碍与IL-1、IL-2和TNF含量变化的相互关系

目的·· :探讨海洛因依赖者戒断时睡眠障碍的原因及其严重程度与IL -1、IL -2和TNF含量变化的相互关系。方法·· :应用RIA法测定45例海洛因依赖者戒断时和40例正常人血清中IL -1、IL -2和TNF的含量 ;应用《戒断症状评定量表》中睡眠障碍评定的3个相关项,评定海洛因依赖者戒断时的睡眠障碍的严重程度。结果·· :海洛因依赖者戒断状态时均有中 -重度睡眠障碍 ;其血清中IL -1、IL -2和TNF的含量均较正常组低(P<0.05,P<0.01,P<0.01) ;依赖者的睡眠障碍得分与3种细胞因子含量有显著性负相关 (r= -0.97;r= -0.95;r= -0.90)。结论·· :海洛因依赖者戒断时3种细胞因子含量明显降低,这可能是导致依赖者出现睡眠障碍的原因之一。     

加味血府逐瘀汤合并美沙酮治疗海洛因依赖216例临床疗效观察

目的:观察海洛因依赖患者用加味血府逐瘀汤合并美沙酮替代递减治疗与单用美沙酮治疗的疗效。方法:将216例海洛因依赖患者随机分为两组,治疗组111例采用加味血府逐瘀汤合并美沙酮替代递减治疗;对照组105例单独用美沙酮替代递减治疗。两组在治疗过程中根据病情需要均可加用曲马多和抗焦虑等对症、支持治疗及心理辅导,观察疗程为30天。在美沙酮递减过程中和撤除美沙酮后根据患者出现撤药反应和稽延反应的轻重及平均每例使用曲马多的总量来判定疗效。结果:(1)治疗组出现撤药反应和稽延反应明显轻于对照组(P<0.01);(2)治疗组平均每例使用曲马多剂量也明显少于对照组(P<0.01)。结论:加味血府逐瘀汤合并美沙酮治疗海洛因依赖患者可明显减轻美沙酮递减过程中和撤除后出现的撤药反应和稽延反应。