全麻下纳曲酮快速阿片类脱毒的初步临床经验

目的··：观察全身麻醉下纳曲酮加洛非西定快速阿片类脱毒（ＲＯＤ）的治疗效果。方法··：２３例接受ＲＯＤ的海洛因依赖者与２０例１０ｄ美沙酮替代递减治疗的海洛因依赖者进行比较。接受ＲＯＤ治疗的患者进行气管插管，硫喷妥钠和氯胺酮静脉复合麻醉。麻醉诱导后，给予纳洛酮２ｍｇ，纳曲酮５０ｍｇ。麻醉结束后患者转入戒毒病房旁的监护病房。ＲＯＤ组在麻醉前及麻醉后２４ｈ，对照组在入院时及入院后ｄ５，进行戒断症状评定。结果··：ＲＯＤ组麻醉后２４ｈ的渴求、焦虑和睡眠障碍分显著低于对照组（Ｐ＜０．０１），腹泻分高于对照组（Ｐ＜０．０１），骨骼肌肉疼痛、恶心呕吐及总分与对照组相当（Ｐ＞０．０５）。ＲＯＤ组麻醉后２４ｈ戒断症状总分与海洛因使用量有相关关系（ｒ＝０．４２１，Ｐ＜０．０１）。ＲＯＤ组有７８．２６％的患者接受纳曲酮维持，而对照组只有１０％的患者接受。结论··：ＲＯＤ是一项可选择的脱毒方法

PRELIMINARY CLINICAL EXPERIENCE OF RAPID OPIATE DETOXIFICATION WITH NALTREXONE UNDER GENERAL ANAESTHESIA

Objective: Rapid opiate detoxification (ROD) under general anaesthesia combining long-acting opiate antagonist naltrexone and lofexidine was investigated. Method: The outcome of ROD in 23 heroin addicts compared with 10-day treatment of methadone substituent gradually reduced therapy in 20 heroin addicts was described. The subjects accepted ROD were intubated, ventilated and anaesthetized with thiopental sodium and ketamine intravenously. Shortly after induction of anaesthesia, naloxone 2 mg and naltrexone 50 mg were administered. After anaesthesia the patients were transferred back to the intensive care unit nearby addiction ward. Before and 24 hours after anaesthesia in ROD group, before and 5 days after admission in control group the withdrawal symptoms were rated. Result: Craving, anxiety and sleep disturbance scores 24 hours after anaesthesia in ROD group were lower compared with control group 5 days after admission(P<0.01), diarrhea scores were higher than the control (P<0.01), aching bone and muscles, nausea and vomiting, and total scores were equal to that of the control (P>0.05). There was correlation between withdrawal symptom total scores 24 hours after anaesthesia in ROD group and consumption of heroin (r=0.421,P<0.01). 78.26% patients in ROD group received naltrexone maintenance, only 10% patients in control group did. Conclusion: The results suggest that ROD is an optional detoxification method.