伏隔核毁损术对吸毒者酒精及尼古丁依赖的影响(附68例分析)

目的 研究伏隔核毁损术对阿片类药物依赖病人酒精及尼古丁依赖的影响。方法 对接受伏隔核毁损术的68例阿片类药物依赖伴酒精及尼古丁依赖病人进行随访，采用吗啡尿检及纳络酮催瘾实验判别术后是否阿片类药物复吸，采用饮酒问卷及尼古丁依赖自评量表对术前、术后不同时期酒精、尼古丁依赖程度进行评分并比较。采用问卷法调查术后病人再次饮酒、吸烟时主观感觉的变化。将饮酒及吸烟后的轻松、兴奋感分为增加，无变化和减弱三个等级，分析手术治疗阿片类药物依赖合并酒精及尼古丁依赖的疗效的相关性。结果 术后12个月，阿片类药物复吸率为54．8％，酒精及尼古丁依赖程度术前吸毒时和术前生理脱毒治疗时差异无统计学意义：术后酒精及尼古丁依赖程度为：术后0．5个月〈术后3个月〈术后6个月，而术后6个月与术后12个月比较差异无统计学意义．但仍远低于术前生理脱毒治疗时的水平。结论 针对阿片类药物依赖病人实施的伏隔核毁损术不但能明显降低吸毒者阿片类药物的心理依赖程度．而且对酒精及尼古丁依赖也有明显的抑制作用。

Effects of stereotactic lesioning of the nucleus accumbens on the alcohol and nicotine dependence in drug abuser: analysis of 68 cases

Objective To study the effects of stereotactic lesioning of bilateral nucleus accumbens on the alcohol and nicotine dependence of patients with opioid drug dependence. Methods Long-term follow-up was carried out in 68 patients with opioid drug dependence that had underwent stereotactic lesioning of bilateral nucleus accumbens and suffered alcohol and nicotine dependence contemporaneously. Morphine uroscopy and naloxone test was applied to differentiate if relapse occurred after surgery. Alcohol questionnaire and Fagerstrom test were used to grade the alcohol dependence and the nicotine dependence, respectively, of the patients in the different stages following the surgery and the 2 kinds of dependence between the pre- and post-operation compared. Euphoria after drinking alcohol or smoking was graded as increase, no change and decrease and compared with that of the pre-operation. The questionnaire was applied to investigate the change of euphoria pre- and post- operation. Correlativity between results of opioid drug dependence and alcohol and nicotine was analyzed. Results The relapse rate of opioid 12 months after the operation was 54.8%. Before the operation, the degree of alcohol and nicotine dependence has no significantly difference between drug-taking and physiological detoxification. Alcohol and nicotine dependence was markedly alleviated halfa month after operation but slightly increased 3-6 months after operation. The degree of alcohol and nicotine dependence showed no significant difference between 6 and 12 months postoperation, and the alcohol and nicotine dependence was still significantly lower than that before the operation. Conclusion Stereotactic lesioning of bilateral nucleus accumbens can greatly alleviate not only the opioid psychic dependence, but also the alcohol and nicotine dependence.