血液灌流串联血液透析与美沙酮脱毒的前瞻性临床研究

目的观察血液灌流串联血液透析对海洛因成瘾者短期脱毒的疗效。方法选取35例海洛因成瘾患者,随机分为血液净化组(16例)和药物组(19例)。血液净化组患者接受血液灌流串联血液透析治疗3次,每天1次;药物组患者采用美沙酮10 d递减疗法。观察两组患者治疗前和治疗后第1,2,3,5,7,10,14,21,30 d的戒断症状,用戒断症状评分量表(the short opiate withdrawal scale,SOWS)评分,用放射免疫法测定血和尿中吗啡的浓度。结果整个治疗过程中,血液净化组和药物组SOWS评分分别为(4.3±3.8)分和(10.1±4.5)分,差异有统计学意义(P<0.01),从第2 d开始,血液净化组的戒断症状均轻于药物组,差异均有统计学意义(均P<0.05);两组问血吗啡浓度的差异无统计学意义(P>0.05),但对两组问同一天的血吗啡浓度值比较,从第3 d至第7 d,差异均有统计学意义(均P<0.05);两组问尿吗啡浓度的差异有统计学意义(P<0.05),从第3 d开始,血液净化组的尿吗啡平均浓度都低于药物组(均P<0.05)。结论血液灌流串联血液透析是一种安全有效的脱毒方法,短期疗效优于美沙酮。

Advantages of heroin detoxification using combined hemoperfusion-hemodialysis method compared to the conventional methadone method:a prospective and randomized clinical study

Objective To evaluate the advantages of heroin detoxification using the combined hemoperfusionhemodialysis method.Methods Thirty-five heroin-addictive patients were randomly divided into the treatment group（n= 16） and the control group（n= 19）.Patients in treatment group were treated with the combined hemoperfusionhemodialysis regimen 3 hours daily for 3 days,while patients in control group received the 10-day methadone treatment regimen.The Short Opiate Withdrawal Scale（SOWS） was used to compare the withdrawal symptoms. Concentrations of morphine in blood and urine were detected by radioimmunoassay method before the treatment and after the treatment for 1,2,3,5,7,10,14,21 and 30 days.Results Compared to the control group,the combined hemoperfusion-hemodialysis regimen had significantly lower mean SOWS score（4.3±3.8 vs.10.1±4. 5,P0.001）.From the second day after treatment,the withdrawal symptoms in the treatment group were less severe than those in the control group（P0.05 to all observation days after treatment）.The difference of mean blood morphine concentration between the two groups was insignificant in the first 2 days（P0.05）,but became significant from 3rd day to 7th day（P0.05,respectively）.From the 3rd day after the treatment,urinary morphine concentration was significantly lower in treatment group than in control group（P0.05 to all observation days after treatment）.Conclusion The combined hemoperfusion-hemodialysis regimen is a safe and effective method for heroin detoxification,and has better outcomes than methadone therapy.