海洛因瘾康期使用纳曲酮防止复吸100例

目的：观察盐酸钠曲酮防止海洛因依赖者戒毒后复吸疗效。方法：ｍｏ１￣２每日口服纳曲酮片１５￣２０ｍｇ，ｍｏ３￣４服１０￣１５ｍｇ，ｍｏ５￣６服５￣１０ｍｇ，６ｍｏ为一个疗程。结果：３ｍｏ复吸率为４２％，６ｍｏ复吸率为７２％，显效率为４５％，有效率为７４％。结论：服药后可明显减轻海海因依赖者对毒品渴求感和焦虑症状，降低复吸率。纳曲酮本身无依赖性，副作用轻微。     

纳曲酮预防海洛因瘾戒断后复吸

目的：观察纳曲酮对海洛因依赖戒断后抗复吸疗效。方法：海洛因依赖戒断后１００例（男性７７例，女性２３例；年龄２６±ｓ４ａ），所有病例戒毒后观察５～１０ｄ以上，服用纳曲酮前，经尿吗啡含量检查与纳洛酮催瘾试验阴性，口服纳曲酮５ｍｇ无反应，次日开始于饭后服用２０～３０ｍｇ／ｄ，无反应者可带药出院继续服用观察。结果：观察１００例，最长１例达４ａ余，除其中失访１０例外，保持３７例（４１％），复吸５３例（５９％）。结论：说明坚持服用纳曲酮，可使复吸率明显下降。     

纳曲酮预防海洛因瘾戒断后复吸

目的：观察纳曲酮对海洛因依赖戒断后抗复吸疗效，方法：海洛因依赖戒断后１００例（男性７７例，女性２３例，年龄２６±ｓ４ａ），所有病例戒毒后观察５～１０ｄ以上，服用纳曲酮前，经尿吗啡含量检查与纳洛酮催瘾试验阴性，口服纳曲酮５ｍｇ无反应，次日开始于饮后服用２０～３０ｍｇ／ｄ。无反应可带药出院继续服用观察。结果；观察１００例，最长１例达４ａ余，其除中失访１０例外，保持３７例（４１％），复吸５３例（５９％     

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。     

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     

快速脱毒加纳曲酮栓植入治疗海洛因依赖

目前公认海洛因依赖是一种慢性中毒性脑病。高复吸率是其特点。如何控制海洛因依赖患者的复吸率。提高戒毒的效果，是药物依赖治疗专业不断探讨的一个课题。盐酸纳曲酮是目前防止海洛因依赖复吸的唯一一种药物。而一般戒毒方法在自愿戒毒机构很难成功接受纳曲酮治疗，结果其戒毒复吸率高达90％-99％，而即使接受纳曲酮治疗后，因为海洛因患者的特点。服药的顺从性差．半年操守率仅达20％-30%，更谈不上长期操守，复吸率仍居高不下。     

美沙酮、丁丙诺啡、可乐定、纳曲酮“阶梯式”疗法治疗海洛因依赖脱毒后复吸患者33例

采用美沙酮、丁丙诺啡、可乐定、纳曲酮为主药的“阶梯式戒毒疗法”，治疗３３例戒毒后屡次复吸的海洛因依赖者。成功戒断８例，已操守０．５ａ以上，停服纳曲酮２个月以上；仍在服纳曲酮１６例，已分别服用１－４个月，操守率７２．７％；失败９例，其中服纳曲酮１－２个月后又复吸海洛因４例，治疗中失去联系而脱试３例，服纳曲酮１次后，戒断症状重而中止，改为自然康复２例，失败率２７．３％；配合心理疏导，有显著抗复吸作用，心理依赖降低，戒毒效果良好。     

美沙酮,丁丙诺啡,可乐定,纳曲酮“阶梯式”疗法治疗海…

采用美沙酮、丁丙诺啡、可乐定、纳曲酮为主药的“阶梯式戒毒疗法”，治疗３３例戒毒后屡次复吸的海洛因依赖者。成功戒断８例，已操守０．５ａ以上，停服纳曲酮２个月以上，仍在服纳曲酮１６例，已分别服用１－４个月，操守率７２．７％，失败９例，其中服纳曲酮１￣２个月后复吸海洛因４例，治疗中失去联系而脱试３例，服纳曲酮１次后，戒断症状重而中止，改为自然康复２例，失败率２７．３％，配合心理疏导，有显著抗复吸作用，心     

国产盐酸纳曲酮用于海洛因依赖者脱毒后预防复吸效能的双盲对…

本文报告１１例海洛因依赖者脱毒后用盐酸纳曲酮及安慰剂进行防复吸的双盲对照研究。结果８例治疗组中４例服药保持率６个月以上，３例对照组中１例保持率６例。两组依赖者在服纳曲酮期间，均无复吸海洛因。能坚持长期服药的影响因素有：本人戒毒决心大，愿意接受家人监督，家属长期给予经济及心理上的支持。     

盐酸纳曲酮对阿片类成瘾脱毒后防止复发效能的再评价：1088 …

目的：就盐酸纳曲酮防止阿片类成瘾脱毒后复发的效能进行再评价。方法：１０８８例完成脱毒治疗的海洛因依赖者给予纳曲酮治疗。药物剂量相对固定在４０～５０ｍｇ．ｄ＾－１,并随患者反应调整。治疗期间定期门诊或随访。结果：服用纳曲酮６个月的保持率为３３．４％,与自身同期操守率（２．４％）比较具有显著性差异。服用纳曲酮后,再第洛因的欣快感、渴求程度及偶吸海洛因的发生率均降低。工酮的不良反应轻,包括：睡眠障碍、消     

盐酸纳曲酮对阿片类成瘾脱毒后防止复发效能的再评价──1088例纳曲酮维持治疗临床研究

目的··:就盐酸纳曲酮防止阿片类成瘾脱毒后复发的效能进行再评价。方法··:1088例完成脱毒治疗的海洛因依赖者给予纳曲酮治疗。药物剂量相对固定在40-50mg·d-1,并随患者反应调整。治疗期间定期门诊或出诊随访。结·果·:服用纳曲酮6个月的保持率为33.4%,与自身同期操守率(2.4%)比较具有显著性差异。服用纳曲酮后,再吸海洛因的欣快感、渴求程度及偶吸海洛因的发生率均降低。纳曲酮的不良反应轻,包括:睡眠障碍、消化系统症状和乏力,少数患者转氨酶呈一过性增高。在纳曲酮治疗的同时给予积极的家庭支持和社会帮教,提供生活和就业技能的指导,减少偶吸的机会等措施,有助于提高服药保持时间。结论··:进一步证实了纳曲酮对预防我国阿片类依赖者脱毒后复吸具有肯定的辅助治疗作用。     

快速脱毒加纳曲酮栓植入治疗海洛因依赖疗效观察

目的:寻找一种安全、有效、可靠、病人能够接受的治疗方法,以降低海洛因依赖病人的复吸率。方法:使用全麻下快速药物拮抗脱毒加纳曲酮栓植入方法,治疗海洛因依赖69例,并通过随访的方式跟踪治疗效果。结果:植入长效纳曲酮缓释栓6个月后,患者对海洛因渴求程度分值从植入前2.21±s0.58降至0.21±s0.14,再尝试海洛因率从81.25%降至5.00%。肝功能与植入前相比无明显变化。结论:全麻快速脱毒加长效纳曲酮缓释栓植入的治疗方法安全、有效、可靠,值得推广使用。     

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     

Depot naltrexone: long-lasting antagonism of the effects of heroin in humans

RATIONALE: Naltrexone, an opioid antagonist, is currently approved as a treatment for heroin dependence. However, naltrexone is generally not well accepted by patients, and medication non-compliance is a difficult obstacle to treatment. A sustained-release form of naltrexone may improve compliance. OBJECTIVE: The present study was designed to evaluate the time course, safety, and effectiveness of a depot formulation of naltrexone (Depotrex). METHODS: Twelve heroin-dependent individuals participated in an 8-week inpatient study. After a 1-week detoxification period, six participants received 192 mg naltrexone base and six participants received 384 mg naltrexone base. For safety, the low dose of depot naltrexone was tested before the high dose. The effects of heroin (0, 6.25, 12.5, 18.75, 25 mg, i.v.) were evaluated for the next 6 weeks. One dose of heroin was tested per day on Mondays through Fridays, and the entire dose range was tested each week. Active heroin doses were administered in ascending order during the week, while placebo could be administered on any day. Subjective, performance, and physiological effects were measured both before and after heroin administration. The hypotheses were that depot naltrexone would antagonize the effects of heroin, and that the high dose of depot naltrexone would produce a more effective and longer-lasting antagonism than the low dose. RESULTS: The low and high doses of depot naltrexone antagonized heroin-induced subjective ratings for 3 and 5 weeks, respectively. Plasma levels of naltrexone remained above 1 ng/ml for approximately 3 and 4 weeks after administration of 192 mg and 384 mg naltrexone. Other than the initial discomfort associated with the injection of depot naltrexone, there were no untoward side-effects. CONCLUSIONS: These results suggest that this depot formulation of naltrexone provides a safe, effective, long-lasting antagonism of the effects of heroin.     

综合疗法对海洛因依赖患者复吸的影响

目的:观察海洛因依赖患者在住院过程中进行综合性治疗(美沙酮递减脱瘾、生物体适应性平衡调整、心理干预、纳曲酮的应用)对出院后复吸的影口向。方法:将海洛因依赖患者90例,按随机化方法分为综合治疗组、美沙酮纳曲酮组及单纯美沙酮治疗组各30例。观察三种治疗方案临床疗效及出院后半年复吸率。结果:综合治疗方案及美沙酮纳曲酮治疗方案在控制脱毒后稽延性戒断症状,缓解焦虑情绪、改善睡眠及降低心理渴求方面均优于单纯美沙酮脱瘾治疗(P<0.01),且出院后半年操守人数亦有显著差异(P<0.01)。综合治疗组半年复吸率降低66.67%。综合治疗方案的临床疗效及防复吸效果又优于美沙酮纳曲酮组(P<0.05)。结论:综合治疗方案临床操作简单易行,临床疗效显著,对海洛因依赖患者脱毒出院后的复吸起到积极预防作用,值得推广。     

A randomised, controlled trial of low dose naltrexone for the treatment of opioid dependence

AIM: To investigate the efficacy of low doses of naltrexone in relapse prevention for heroin dependence. DESIGN: Double blind, randomised comparison of three groups-Group 1 taking 50mg per day, Group 2: 0.5mg per day, and Group 3: 0.05 mg per day. PARTICIPANTS: Sixty-six dependent heroin users. INTERVENTIONS: After detoxification followed by 1 week on 50mg per day naltrexone, participants were randomised to trial medication. All were offered counselling and monitored with weekly clinical reviews. Research interviews were conducted at three and 6 months. OUTCOME MEASURES: Retention in treatment and heroin use at 3 and 6 months. Secondary outcome measures were side effects and craving. FINDINGS: Mean days retained in randomised treatment were-Group 1: 58.9 days; Group 2: 46.6 days; and Group 3: 47.8 days. Differences in retention were not significant using survival analysis. However, nine of the first 60 participants, transferred to the 50 mg dose, and one transferred to a lower dose (chi-square = 0.142; P = 0.018). At follow-up, there was no relationship between abstinence from heroin and naltrexone dose, nor between level of heroin use and dose. There were no differences between groups in craving or depression. CONCLUSION: Low doses of naltrexone had no discernible advantage, and participants preferred 50mg per day. Despite preference for blocking doses of naltrexone, outcomes appeared to be independent of naltrexone dose.     

Preclinical study of an oral controlled release naltrexone complex in mice

Naltrexone, a long-acting, orally effective, opioid antagonist which blocks opioid effects as well as the development of physical dependence, would appear to be a drug ideally suited to addiction treatment. An optimal dosage regimen is critical for the treatment patient compliance in ambulatory opiate detoxification programs. The ideal dosage regimen would be an oral controlled-release system of naltrexone that allowed once-a-day administration providing stable plasma levels. A naltrexone-Eudragit L complex was produced in aqueous medium from naltrexone hydrochloride solution and Eudragit L30D (30% w/v) previously diluted (6% w/v) and partially neutralized. The antagonistic activity of naltrexone-Eudragit L on morphine-induced thermal antinociception, in comparison with conventional naltrexone, was evaluated, using the mouse hot-plate model. Mice were administered 10 mg kg(-1) morphine subcutaneously, 10 min before test, and the antagonist products, either naltrexone-Eudragit L or naltrexone hydrochloride, were administered orally at 0.5, 1, 2, 4, 6, 8, 10, 12, 14 and 16h before the test. The results showed that the antagonism induced by naltrexone-Eudragit L was effective until 12 h after drug administration, while that induced by naltrexone hydrochloride disappeared 10 h after its administration. A 23.47% increase of the area under curve was obtained when naltrexone-Eudragit L was administered, compared with that induced by conventional naltrexone. The time taken to decrease the inhibition of analgesic activity to 50% was delayed by 51.80%. This complexation technique can be considered as a useful tool in the design of oral controlled-release systems capable of inducing a long-lasting effect in-vivo.     

纳曲酮用于海洛因依赖治疗

目的 :了解纳曲酮抗复吸治疗效果。方法 :采用回顾性临床资料分析方法 ,分析 5 0例海洛因依赖者躯体脱毒后使用纳曲酮抗复吸治疗的临床资料。结果 :应用纳曲酮抗复吸治疗 6个月 ,患者对海洛因渴求程度分值从1 96±s 0 88降至 0 2 5±s 0 4 4 (P <0 0 1) ,复吸率从 2 8 6 %降至 5 0 % (P <0 0 1) ,17例原静脉注射毒品者复吸时11例改为烫吸 ,1例改为肌肉注射。结论 :纳曲酮能减轻或消除海洛因正性强化作用 ,间接淡化患者对海洛因的渴求程度 ,降低复吸率 ,无明显毒副作用 ;可使静脉注射海洛因者改变滥用方式 ,降低毒品危害