海洛因依赖患者自然戒断状态下症状频谱的动态变化

目的 :了解自然戒断状态下不同时期戒断症状发生率的动态变化以及导致患者复吸的主要原因。方法 :对 15 8例强制戒毒病人 ,于戒断后 2 4小时 ,72小时 ,7天 ,10天 ,1月 ,3月进行戒断症状评定。结果 :急性期戒断症状以焦虑、渴求、失眠、疲乏、食欲减退、疼痛、出汗、流泪、流涕、呵欠等症状的发生频率为高 ,而急性脱瘾后恢复期则以渴求、失眠、疲乏、焦虑 ,性欲望减退、情绪抑郁等为主要表现。导致病人复吸的主要原因依次为心理渴求 ,回到吸毒朋友的社交圈 ,睡眠障碍、周身不适、焦虑不安、空虚无聊、情绪不佳等稽延性症状 ,及来自家庭社会的应激。结论 :海洛因依赖患者在不同的戒断时期症状表现有所不同 ,导致复吸的原因亦多种多样 ,提示在不同戒断时期 ,治疗和预防复吸的方法应有所不同 ,应加强可以人为干预因素的控制 ,减少复吸率。     

Prevalence of human immunodeficiency virus and its association with hepatitis B,C, and D virus infections among incarcerated male substance abusers in Taiwan

Taiwan has been facing a rising epidemic of human immunodeficiency virus (HIV) infection since 2004. Injection drug users comprised 38.5% of accumulated HIV cases by 2007. This cross‐sectional study investigated the seroprevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV), and HIV infection in 753 male substance users who were detained in a detoxification center in Taoyuan, Taiwan. The subjects were enrolled into the study consecutively between February and October, 2005. The seroprevalence rates of HIV antibodies, HCV antibodies, and HBV surface antigens among all subjects, and HDV antibodies among HBV carriers were 6.9% (95% confidence interval [CI]: 5.19–8.95), 30.5% (95% CI: 27.23–33.93), 16.9% (95% CI: 14.24–19.71) and 13.7% (95% CI: 8.19–21.04), respectively. Subjects in the heroin injection group had significantly higher rates of HIV infection, HCV infection and HDV superinfection (25.5%, 89.6%, and 38.7%) than those in the heroin non‐injection group (0.9%, 24.5%, and 6.25%), the methamphetamine group (0.3%, 8.1%, and 6.7%), and the club drug group (1%, 3%, and 0%; P < 0.001). The odds of HCV, HIV, or HDV infection were 74.7, 63.8, and 11.1 higher, respectively, for heroin injection drug users than for non‐injection drug users (P < 0.0001). Compared to HIV‐negative individuals, the odds of being a heroin injector and the odds of HCV co‐infections were 64‐fold and 149‐fold higher, respectively, in HIV‐positive individuals. The impact of HBV, HCV, and HDV infection on the HIV epidemic in Taiwan should be monitored closely. J. Med. Virol. 81:973–978, 2009. © 2009 Wiley‐Liss, Inc.     

生物反馈结合线索暴露治疗降低海洛因依赖者药物线索反应

目的:了解生物反馈结合线索暴露治疗是否降低海洛因依赖者环境线索诱发渴求及心理生理反应.方法:采用前瞻性的队列研究将60例环境线索诱发心理渴求增高的康复期海洛因依赖者分成实验组(n=36)与对照组(n=24),对照组只进行劳教场所的常规帮教,实验组除帮教外进行12次生物反馈结合线索暴露治疗,评估治疗前后环境线索诱发心理渴求与心理生理反应情况.结果:两组治疗结束后,实验组环境诱发前、后的心理渴求,肌电和皮导得分均低于对照组[诱发前:心理渴求(3.06±7.26)mm vs.(22.32±20.26)mm、肌电(8.52±4.23)μV vs.(12.06±5.17)μV、皮导(2.14±1.43)μS vs.(4.61±2.24)μS;诱发后:心理渴求(6.97±10.30)vs.(33.14±25.40)mm、肌电(8.72±4.31)vs.(14.79±5.86)μV、皮导(2.15±1.33)vs.(4.49±2.59)μS,P≤0.01].结论:生物反馈结合线索暴露治疗可降低康复期海洛因依赖者渴求及环境诱发心理生理反应.     

GluN2亚基在海洛因诱导CPP模型大鼠PrL区的表达

目的:研究大鼠内侧前额叶皮质(m PFC)边缘前区(Pr L) Glu N2亚基在海洛因诱导条件位置性偏爱(CPP)及戒断状态的表达。方法:24只SD大鼠随机分为对照组(control)和海洛因诱导组。海洛因诱导组大鼠按实验进程分为两种状态,即海洛因诱导CPP状态(heroin)和海洛因戒断状态(withdrawal)。用小剂量递增法皮下注射海洛因,行大鼠海洛因诱导CPP建模,并自然戒断,免疫荧光染色检测各组大鼠Pr L区Glu N2亚基NR2A、NR2B、NR2C、NR2D的表达。结果:大鼠经过连续7 d小剂量递增法注射海洛因,形成了稳定的CPP;免疫荧光染色结果显示,大鼠CPP状态Pr L区NR2B表达较对照组显著增强(P <0. 01),其他亚基无明显变化。海洛因自然戒断7 d后,戒断状态大鼠Pr L区NR2A、NR2C表达较对照组和CPP状态皆显著增强(P <0. 01)。戒断状态NR2B表达水平显著高于对照组(P <0. 01),但与CPP状态无显著差异。结论:大鼠海洛因依赖CPP的形成与Pr L区NR2B亚基的活性密切相关,NR2A和NR2C可能参与药物戒...     

海洛因依赖者的神经电生理研究

目的:探讨海洛因依赖者运动诱发电位(MEP),感觉诱发电位(SEP),皮肤交感反应(SSR)检测的临床应用价值。方法:对21例海洛因依赖者和20例正常健康者分别进行MEP、SEP及SSR测定。结果:海洛因依赖者MEP、SEP及SSR与对照组比较有显著性差异。结论:MEP、SEP和SSR异常说明海洛因依赖者神经系统运动、感觉及自主神经传导通路均受到广泛损害,联合应用可提供海洛因依赖者神经系统损害的客观依据。     

Substance abuse and movement disorders

An array of movement disorders is associated with ethanol, illicit drugs, and tobacco. Heavy ethanol users experience withdrawal tremor and, less often, withdrawal parkinsonism, chorea, and myoclonus. Asterixis is a feature of hepatic failure. On the other hand, ethanol can ameliorate essential tremor and myoclonus‐dystonia. Among opioid drugs, meperidine can precipitate myoclonus. Severe parkinsonism affected users of a synthetic meperidine analog contaminated with 1‐methyl‐4‐phenyl‐1,2,3,6‐tetrahydropyridine. Spongiform leukoencephalopathy, sometimes with chorea and myoclonus, occurred in inhalers of heroin vapor (chasing the dragon). Psychostimulants including cocaine acutely cause stereotypies and dyskinesias. Phencyclidine toxicity causes myoclonus. Tobacco use, on the other hand, protects against Parkinson's disease. Clinicians need to consider substance abuse in patients with unexplained movement disorders. © 2010 Movement Disorder Society.     

海洛因中毒的特点和救治

目的　探讨海洛因中毒患者的临床特点、救治的措施和中毒的原因。方法　对 1998年 8月— 2 0 0 2年 10月来我院救治的 12例海洛因中毒患者临床资料进行回顾分析。结果　海洛因中毒的主要原因 :超量使用 ,药物耐受性改变 ,多药滥用。海洛因中毒患者的主要临床特点为 :呼吸抑制、意识昏迷、针尖样瞳孔。治疗强调立即开放气道、给氧 ,早期适量静脉注射纳络酮等措施。结论　海洛因中毒有特定的临床表现 ,早期应用纳络酮对抢救海洛因中毒具有重要意义     

济泰片治疗轻度海洛因依赖者稽延性戒断症状的随机双盲对照研究

目的探讨济泰片治疗轻度海洛因依赖者稽延性戒断症状的有效性和安全性,为降低轻度海洛因依赖者的复吸率提供参考。方法在河南省新乡市第一强制隔离戒毒所选取符合《精神障碍诊断与统计手册(第4版)》(DSM-IV)诊断标准的轻度海洛因依赖者81例,采用随机数字表法分为济泰片组(n=40)和对照组(n=41)。济泰片组接受济泰片治疗,对照组给予济泰模拟片,两组均治疗24周。采用海洛因依赖稽延性戒断症状评定量表(RSPWSHA)评定疗效,采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表17项版(HAMD-17)及海洛因渴求问卷(HCQ)评定焦虑、抑郁症状和心理渴求程度,治疗期间监测药物不良反应、生命体征和实验室检查指标评估安全性。结果济泰片组和对照组RSPWSHA、HAMA、HAMD-17及HCQ总评分随治疗时间延长而降低(P0.05),RSPWSHA总评分减分率随治疗时间延长而增加(P0.05)。治疗8周后两组HCQ评分和治疗24周后两组HAMD-17总评分比较差异有统计学意义(P0.05),其他各治疗时点两组各量表评分比较差异均无统计学意义(P均0.05)。结论济泰片治疗轻度海洛因依赖者稽延性戒断症状可能疗效不明确。     

海洛因稽延性戒断症状的初步调查

目的:从中医学角度出发了解阿片类依赖者脱毒后的稽延性戒断症状,指导中医药发挥在脱毒后康复中的优势,防止复吸。方法:采用稽延性戒断症状评定表对100例脱毒成功者进行测评。结果:阿片类依赖者脱毒成功后,仍普遍存在稽延性戒断症状,主要表现为记忆力减退、抑郁、失眠、疼痛等,而气短,多汗,性欲下降较为严重。结论:稽延性戒断症状的存在是脱毒后病人复吸的重要原因。