海洛因依赖伴有癫痫发作19例临床治疗分析

海洛因依赖者合并其他成瘾物质滥用的现象极普遍,经常是同时滥用几种药物。海洛因依赖者不但产生心理依赖,而且生理依赖也相当严重,海洛因和其他滥用药物进入大脑,调控大脑神经元细胞的γ-氨基丁酸(GABA)的释放和信号传递而导致放电异常[1],这可能是海洛因里残杂滥用药物诱发癫痫的一个主要原因。但是在人体内观察海洛因依赖者合并其他成瘾物质滥用诱导癫痫发作很少有相关的临床报道,本文资料分析3033例海洛因依赖者合并其他成瘾物质滥用患者,在脱毒治疗     

100例海洛因依赖者常见并发症的调查分析

目的了解海洛因依赖者常见并发症。方法对100例自愿戒毒的海洛因依赖者进行面谈,将其首次滥用海洛因的年龄、滥用年限、日滥用量以及滥用海洛因后躯体状况,分别给予记录,并就日滥用量,滥用年限与性别方面分别与各并发症进行统计学分析。结果体质量减轻56例、消化系统并发症51例、便秘47例、口腔并发症46例、呼吸系统并发症40例。不同滥用年限便秘发生率有显著性差异(P<0.05),滥用年限长者便秘发病率高;不同日滥用量呼吸系统并发症发生率有显著性差异(P<0.05),日滥用量大者易并发呼吸系统疾病;不同性别体质量减轻有显著性差异(P<0.05),男性体质量减轻较女性明显。结论在戒毒过程中,护理人员应根据病人的躯体状况,针对性地采取有效的护理措施,以解除戒毒者的躯体疾苦,促进康复。     

上海、广州两地海洛因依赖者的流行病学特点

目的:分析上海、广州两地海洛因依赖者人口学和毒品滥用等特点。方法:以自制的调查表回顾性收集上海、广州两地住院脱毒治疗的海洛因依赖者各630和404例人口学资料、毒品滥用现状及对躯体的影响。结果:两地海洛因依赖者均以青年男性为主、未婚者多、无业闲散人员多、文化程度低等特点,女性吸毒者年龄显著低于男性吸毒者年龄。上海地区海洛因依赖者初中文化、无业、女性比例偏高,广州地区以年轻、个体经营者多见;广州地区吸毒者脑电图异常率、谷丙转氨酶异常比例均高于上海地区,乙肝表面抗阳性比例上海地区吸毒者更高一些,差异有显著性(χ2=269.57,224.53,74.37;P均=0.000);上海海洛因依赖者成瘾的社会、生理诱因比广州明显(χ2=24.01,14.49;P均=0.000),广州海洛因依赖者心理诱因更为显著(χ2=37.58,P=0.000)。吸毒时间、日吸毒剂量、脱毒次数上海地区显著少于广州地区,成瘾所需时间前者明显长于后者(t=3.77,13.77,7.42,3.99;P均=0.000)。结论:上海、广州两地海洛因依赖具有不同人文、经济环境等流行病学特点,前者的防治须重视群体化,后者须注重个体化。     

海洛因依赖者的脑CT表现及不同戒毒治疗方法的疗效研究

目的了解海洛因依赖者脑CT表现及不同戒毒治疗方案的疗效。方法对72例海洛因依赖者与50例正常对照者的脑CT表现进行对照研究,分析不同戒毒治疗方法的效果。结果部分海洛因依赖者内囊后肢、丘脑及侧脑室周围脑白质、小脑齿状核CT值有不同程度的减低(P0.05);提示海洛因依赖者可能有脑实质损害,此损害与吸毒时间长短、吸毒量多少无显著性差异;海洛因依赖者采用单独美沙酮戒毒治疗和综合治疗的效果有显著性差异。结论海洛因依赖者的戒毒治疗应考虑脑实质损害,辅以营养脑细胞、修复脑损害、恢复脑功能等综合性治疗手段。     

住院管理及护理在自愿戒毒的海洛因依赖者中的实施效果

[目的]探讨住院管理及护理在自愿戒毒的海洛因依赖者戒毒治疗中的实施效果。[方法]选取2015年3月—2019年3月来我院自愿戒毒的56例海洛因依赖者作为研究对象,采用随机数字表法将其分为对照组和试验组各28例。对照组给予常规药物治疗和健康宣教,试验组在对照组基础上实施住院管理及护理。于干预前、干预后3个月、干预后6个月评估两组海洛因依赖者的海洛因渴求情况和整体健康状况。[结果]干预后,试验组海洛因渴求问卷得分低于对照组,健康状况调查问卷得分高于对照组,两组比较差异均有统计学意义(均P0. 05)。[结论]在常规药物治疗和健康宣教基础上对海洛因依赖者实施住院管理及护理有利于减轻海洛因依赖者对海洛因的渴求程度,改善海洛因依赖者的健康状况。     

海洛因依赖者HIV和HCV感染情况分析

目的：了解海洛因依赖者HIV、HCV感染现状。方法对565例海洛因依赖者进行HIV、HCV血清学检测,比较不同性别、不同民族的海洛因依赖者感染病毒的情况。结果在565例海洛因依赖者中,男性的HIV、HCV和HIV/HCV合并感染率分别为14．57％（72/494）、59．72％（295/494）、13．36％（66/494）,女性分别为19．72％（14/71）、77．46％（55/71）、16．90％（12/71）,男性HCV感染率显著低于女性（P＜0．05）。汉族与维吾尔族海洛因依赖者之间比较,HIV、HCV及HIV/HCV合并感染率差异均有统计学意义（P＜0．05）。结论海洛因依赖者是感染HIC、HCV的高危人群,需加强毒品和传染病预防知识的宣传教育,以控制疾病传播,减少疾病发生。     

博乐欣治疗海洛因依赖者情绪障碍的临床观察

目的：探讨海洛困依赖者情绪障碍的临床特点及治疗。方法：对68例海洛因依赖者在脱毒后的一周内，测查汉密顿焦虑（HAMA）量表和汉密顿抑郁（HAMD）量表；把68例随机分为对照组27例和药物处理组41例。对照组仅给予简单的言语解释和支持，药物处理组给予博乐欣150mg／日治疗。四周后对所有依赖戒断者复查HAMA、HAMD量表，并进行疗效评定。结果：发现海洛因依赖戒断者有明显的焦虑、抑郁等情绪障碍，药物处理组使用博乐欣治疗4周后，HAMA、HAMD评分明显下降（除睡眠障碍）并与对照组相比有显著差异（P〈0．01）结论：海洛因依赖戒断者很容易出现焦虑和抑郁情绪障碍，在其脱毒后早期使用抗抑郁药博乐欣。对于海洛因依赖戒断者的情绪障碍具有较好疗效。     

34例海洛因依赖者伴抗焦虑药物有害使用者临床分析

目的 了解海洛因依赖者有害使用抗焦虑药物的临床特点。方法 对34例海洛因依赖者伴抗焦虑药物有害使用者的临床资料进行回顾性分析。结果 海洛因依赖者有害使用抗焦虑药物的频度为49．27％；1．45％存在抗焦虑药物依赖。抗焦虑药物有害使用频度依次为阿普唑仑、地西泮、三唑仑、艾司唑仑、氯硝西泮。本组有8例合并使用曲马多、氯氮平、氯丙嗪等。使用目的多为缓解失眠，改善情绪。经治疗28例(83．35％)好转，6例(17．65%)治愈。结论 海洛因依赖的戒断与稽延症状为海洛因依赖者有害使用抗焦虑药物的主要动力，脱毒治疗应延长至足够时间。     

海洛因依赖者的心理特征与心理护理

海洛因依赖即毒品滥用者在精神和躯体上均产生了对毒品的严重依赖,一旦停用则出现戒断症状,其症状的轻重取决于滥用海洛因的剂量、次数、时间长短及滥用方式的不同。由于这类患者的身心健康均受到毒品的严重摧残,其心理社会问题复杂,我科在对这类患者实施系统化的整体护理过程中,重点突出心理护理。现将我科收住的15例海洛因依赖者心理护理体会分析报告如下:     

经皮穿刺冠状动脉内支架植入术治疗冠心病48例术后护理

海洛因依赖是一个全球性问题。滥用海洛因不仅给社会造成许多不安定隐患,也给滥用者个体和家庭带来严重的身心健康问题,为使海洛因依赖者更好地配合治疗,从而脱毒成功。2001年9月～2002年2月,我们对380例自愿戒毒患者给予精心护理,取得满意效果。现报告如下。     

凉山彝族地区800例中老年人骨密度调查

[目的]探讨凉山彝族地区中老年人骨密度（Bone mineral density BMD） 的状况及骨质疏松症的发病率,为骨质疏松防治提供科学依据.[方法]对长期居住在凉山彝族地区的45岁以上的中老年人群800名（男女各400名）,准确记录性别、年龄及种族,采用双能x线骨密度仪进行腰椎（L1~L5）前后位BMD测量,并按5岁为一个年龄组分组.以峰值BMD减低2.5 标准差（s）为诊断骨质疏松症标准.[结果]随年龄增加骨密度逐渐下降（P＜0.05）,女性55岁后骨量下降较男性显著（P＜0.05）,骨质疏松患病率随年龄增加而上升（P＜0.05）,女性高于男性（P＜0.01）.[结论]凉山彝族地区中老年人群随着年龄的增长,BMD逐渐降低,骨质疏松患病率明显增加,女性更为明显,彝族老年人骨质疏松较汉族老年人发病偏少（P＜0.05）,可能与彝族人居住在高山地区,交通不便,多以步行及体力劳动较多有关.     

Controlled clinical trial to assess the response of recent heroin abusers with chronic hepatitis C virus infection to treatment with interferon alpha-n2b

BACKGROUND: Chronic infection with hepatitis C virus (HCV) is the most common infectious disease among heroin abusers, but it is recommended that specific treatment with interferon be delayed until at least 6 to 12 months after the end of drug addiction. OBJECTIVE: We investigated the response of heroin abusers to interferon treatment shortly after the end of detoxification treatment with methadone. METHODS: We studied 2 homogeneous groups of white Italian patients with chronic HCV infection: former male heroin abusers and males without a history of drug addiction. Tumor necrosis factor, interleukin-1beta, interleukin-2, activated monocytes, anti-HCV antibodies, HCV RNA, and alanine aminotransferase levels were assessed. Standard treatment was initiated with 5 MU interferon alpha-n2b administered subcutaneously once daily for 8 weeks. Patients with negative HCV-RNA findings at the end of 8 weeks received further treatment with 5 MU TIW subcutaneously for an additional 48 weeks. RESULTS: Thirty of 47 patients in group A (former heroin abusers) and 30 of 30 patients in group B (controls) completed the study. Heroin abusers presented a significantly enhanced response to treatment compared with the controls. After 8 weeks, HCV-RNA test results were negative in 27 of 30 patients in group A (90.0%) and in 25 of 30 in group B (83.3%) (P = NS). Onset of relapse occurred significantly later in heroin abusers (mean [SD], 53 [3] weeks) than in controls (26 [2] weeks) (P < 0.05). Cytokine levels and activated CD11 antigen-expressing monocytes were significantly (P < 0.001) higher in heroin abusers than controls. CONCLUSION: Heroin abusers with chronic HCV infection were successfully treated with interferon alpha-n2b soon after the end of detoxification treatment.     

ICAM-1基因K469E、K56M多态性对中国裕固族、藏族和汉族人血浆ICAM-1水平的影响

本研究检测中国裕固族、藏族和汉族3个民族人群血液中细胞间黏附分子-1(ICAM-1)基因K469E(A/G,rs5498)和K56M(A/T,rs5491)的基因多态性及血浆中可溶性ICAM-1(sICAM-1)水平,分析其基因型和等位基因频率在不同民族人群中的分布,探讨ICAM-1基因2个多态性位点对血浆中sICAM-1水平的影响。采集327例裕固族、400例藏族及126例汉族人群EDTA抗凝静脉血,采用大量全血基因组DNA提取试剂盒提取DNA,以PCR-RFLP进行DNA多态性分析,琼脂糖凝胶电泳后在凝胶扫描成像系统下判断基因型,DNA测序确定基因序列,比较ICAM-1基因型和等位基因频率在不同群体中的分布,通过Hardy-Weinberg遗传平衡定律检验群体代表性。采用人ICAM-1 ELISA试剂盒检测各民族人群血浆中sICAM-1水平。结果表明,DNA测序与PCR-RFLP分析结果一致。本研究检测到裕固族、藏族及汉族3个民族ICAM-1基因K469E位点KK、KE、EE 3种基因型,但它们的分布差异没有统计学意义,而K、E等位基因频率分布的差异有统计学意义(P<0.05)。裕固族和藏族分别与汉族群体之间的基因型和等位基因频率分布差异都有统计学意义(P<0.05)。K56M位点在3个民族中只检测出KK、KM 2种基因型,尚未检测到MM基因型;2种基因型和K、M等位基因频率分布在裕固族与汉族群体之间差异有统计学意义(P<0.05)。3个民族人群ICAM-1基因型和等位基因频率无明显性别比例和年龄分布差异,分布符合Hardy-Weinberg遗传平衡定律(P>0.05)。ICAM-1 K469E位点含K等位基因个体的sICAM-1血浆水平〔(253±122),(185±97)μg/L)〕高于不含K等位基因的个体〔(145±110)μg/L,P<0.01〕。ICAM-1 K56M位点含KK基因型的个体的sICAM-1血浆水平〔(253±122)μg/L〕高于KM基因型的个体〔(168±103)μg/L,P<0.01〕。裕固族和藏族群体中sICAM-1血浆水平〔(224±800),(214±111)μg/L〕高于汉族群体〔(175±125)μg/L,P<0.05〕,两两比较显示,裕固族与汉族群体及藏族与汉族群体中sICAM-1血浆水平差异有统计学意义(P<0.05)。结论:裕固族、藏族和汉族人群的ICAM-1 K469E和K56M 2个氨基酸位点基因型和等位基因频率均以KK/KE型、KK型和K等位基因为主,且裕固族和藏族的高于汉族,性别年龄间无明显差异,本研究对象中的ICAM-1基因型和等位基因频率分布具有群体代表性。ICAM-1基因K469E和K56M多态性影响血液中sICAM-1的血浆水平。K469E基因的K等位基因可能是某些疾病遗传危险因素,而K56M基因的M等位基因可能是其遗传保护因素。     

蒙汉两族12岁年龄组恒牙龋患病情况调查及相关因素分析

【目的】了解内蒙古锡林浩特市两所中学蒙汉两族12岁年龄组人群恒牙龋病情况,为本市口腔卫生保健提供相关信息。【方法】按照《第3次全国口腔健康流行病学调查方案》,采用分层随机抽样的方法,抽取内蒙古锡林浩特市蒙古族中学12岁年龄组1243人,进行口腔健康状况的流行病学调查。【结果】蒙族12岁年龄组人群恒牙患龋率37．69％显著低于汉族54．81％（P〈0．05）,蒙族恒牙龋均0．88显著低于汉族1．32（P〈0．05）;不同性别蒙汉两族12岁年龄组患龋率存在差异（P〈0．05）,女生龋均显著高于男生（P〈0．05）;当地12岁年龄组患龋率、龋均高于全国水平。【结论】加强口腔健康教育,增强口腔健康知识,饮食习惯对口腔龋齿的发病有一定影响。     

Natural killer cell activity and lymphocyte subsets in parenteral heroin abusers and long-term methadone maintenance patients

We studied natural killer (NK) activity and lymphocyte subsets in 11 active parenteral heroin abusers, 11 long-term methadone-maintained former heroin abusers and 11 apparently healthy individuals. All subjects were males aged 23 to 49 and none had active infectious or inflammatory diseases. All current or former heroin abusers were seronegative for antibody to human immunodeficiency virus. The methadone maintenance patients were socially rehabilitated and had not abused drugs parenterally for at least 10 years. NK activity was determined by a standard Cr-release cytotoxicity assay using K562 cells as targets, and lymphocyte subsets were determined by direct immunofluorescence using flow cytometry. At all three effector-target ratios (100:1, 50:1 and 25:1), NK activity was reduced significantly (P less than .01) in parenteral heroin abusers compared with methadone maintenance patients and apparently healthy individuals. The latter two groups did not differ from each other. Parenteral heroin abusers also had higher absolute numbers of CD2, CD3, CD4 and CD8-positive cells. These data support our hypothesis that significant abnormalities of cellular immunity in parenteral heroin abusers can be normalized by successful long-term methadone treatment.     

Modulation of heroin and cocaine self-administration by dopamine D1- and D2-like receptor agonists in rhesus monkeys

Cocaine-heroin combinations ("speedballs") are commonly self-administered by polydrug abusers. Speedball self-administration may reflect in part an enhancement of the reinforcing effects of the drug combination compared with either drug alone. The present study investigated the degree to which the dopamine receptor system plays a role in cocaine-induced enhancement of heroin self-administration. In rhesus monkeys trained under a progressive ratio schedule of i.v. drug injection, combining heroin with cocaine shifted the heroin dose-response function leftward, and isobolographic analysis indicated that the combined effects were dose-additive. Likewise, combining heroin with the D1-like receptor agonists 6-chloro-7,8-dihydroxy-1-phenyl-2,3,4,5-tetrahydro-(1H)-3-benzazepine HCl (SKF 81297) and 6-chloro-N-allyl-7,8-dihydroxy-1-phenyl-2,3,4,5-tetrahydro-[1H]-3-benzazepine (SKF 82958) resulted in a leftward shift in the heroin dose-response function that was dose-additive. In contrast, combining heroin with the D2-like agonists R-(-)-propylnorapomorphine (NPA) and quinpirole shifted the heroin dose-response function to the right. Isobolographic analysis of the combined effects of heroin with NPA and quinpirole revealed infra-additive interactions in both cases. When combined with cocaine instead of heroin, both the D1-like receptor agonist SKF 81297 and the D2-like receptor agonist NPA enhanced cocaine self-administration. The combinations of SKF 81297 with cocaine were dose additive; however, the NPA-cocaine interaction was infra-additive. Together, the results suggest that D1- and D2-like receptor mechanisms may play qualitatively different roles in the combined self-administration of heroin and cocaine. In particular, stimulation of D1-like receptors enhances self-administration of heroin or cocaine individually, similar to the effects of combining cocaine with heroin, whereas stimulation of D2-like receptors seems to play primarily an inhibitory role.     

Factors associated with relapse among clients in Australian substance disorder treatment facilities

Factors associated with relapse to problematic alcohol or illicit drug use were examined in 104 clients enrolled in treatment programmes for substance disorders. Participants were assessed by retrospective self‐report questionnaires to explore the roles of family dysfunction, mood states, primary drug of dependence, demographic variables and various other factors in relation to relapse episodes. Consistent with previous studies, the most commonly cited reason for relapse was negative mood states, followed by external pressure to use, desire for positive mood states, and social/family problems. Reasons for relapse did not differ between clients whose primary drug of dependence was heroin, methamphetamine, or alcohol. Methamphetamine abusers and participants in the drug court programme had the fewest relapses. Co‐morbid psychological disorders were most commonly diagnosed in the alcoholic group, followed by the methamphetamine group and the heroin group. General family functioning retrospectively improved from time of last relapse to time of testing. Results are consistent with previous work and suggest that relapse factors are remarkably similar across different types of drug dependence.     

维族与汉族女性康复期精神分裂症患者生活质量状况调查

目的 探讨新疆阿克苏地区维族与汉族女性康复期精神分裂症患者的生活质量状况,为提高其生活质量水平提供依据.方法 将30例维族女性康复期精神分裂症患者设为维族组,30例汉族女性康复期精神分裂症患者设为汉族组.自拟一般资料统计表统计两组患者的一般资料,采用世界卫生组织生存质量测定量表评定生活质量,并对可能影响生活质量的因素进行单因素分析.结果维族组世界卫生组织生存质量测定量表生理领域、心理领域、独立性领域、社会关系领域、环境领域和总的生活质量维度分均显著低于汉族组(P＜0.01).结论 维族女性精神分裂症患者的生活质量明显低于汉族,经济状况、生活环境、医疗服务、社会和家庭的支持系统是影响维族妇女精神分裂症患者生活质量的主要因素.     

Descriptive epidemiology of hepatitis C virus among male heroin abusers in Taiwan

BACKGROUND: The purpose of this study was to explore the epidemiology of hepatitis C virus (HCV) infection and to determine the risk factors for HCV infection among heroin abusers in Taiwan. METHODS: This was a cross-sectional study. From November 2004 to February 2005, 577 subjects, including 423 subjects (73.3%) using injectable heroin and 154 subjects (26.7%) using smoked heroin from one male prison located in Taiwan, were enrolled in this study. The mean age was 33.3 +/- 7.9 years (age range 19-65 years). Anti-HCV antibody was tested. A face-to-face interview focusing on sociodemographic information and risk behaviors was addressed. The t test, chi-squared test, and multivariate logistic regression were used. RESULTS: The overall prevalence of anti-HCV antibody positivity was 74.9%, with 89.8% among injecting heroin abusers and 33.8% among smoking heroin abusers (P < 0.0001). The multivariate logistic regression analysis demonstrated that needle sharing was independently related to HCV infection (odds ratio = 5.25, 95% confidence interval = 2.48-11.12). CONCLUSIONS: The prevalence of anti-HCV antibody positivity among male injecting drug abusers is high in Taiwan. Needle sharing is identified as a potential risk factor for HCV infection.     

汉、维吾尔族精神分裂症患者血清甲状腺激素水平对比研究

目的：探讨汉族与维族精神分裂症患者间甲状腺素T3、T4及TSH水平是否有差异。方法：141例精神分裂症患者作为实验组（汉族88例,维族53例）;192例在同一医院住院的非精神分裂症和非内分泌疾病患者作为对照组（汉族96例,维族96例）。对2组患者均进行血清T3、T4及TSH测定并进行比较。结果：2组中维族与汉族患者T3、T4及TSH水平测定均差异无统计学意义;2组间比较,实验组患者T3及T4均低于本民族的对照组（均P〈0.05）,TSH差异无显著性意义;结论：汉族、维族患者间血清甲状腺激素水平无显著变化;精神分裂症患者的甲状腺素有明显改变,可能由于神经递质遗传代谢紊乱所致。