海洛因依赖脱毒期间并发急性胃炎情况分析

目的:研究海洛因依赖者脱毒期间并发急性胃炎情况。方法:对本院2001年1月-2002年12月自愿戒毒所收治的820例自愿戒毒者的病历进行回顾性分析。结果:海洛因依赖者脱毒期间有21例并发急性胃炎,发病率为2·6%。其中急性充血性胃炎16例,占76·2%;急性胆汁返流性胃炎3例,占14·3%;急性糜烂性胃炎2例,占9·5%。结论:海洛因依赖者脱毒期间易发生急性胃炎,其原因与海洛因依赖者机体免疫力下降、应激状态、反流性呕吐、胃肠道平滑肌张力增加、胃粘膜屏障作用下降和感染等因素有关,在脱毒治疗中应予以注意。     

海洛因依赖者脱毒期上消化道出血情况分析

目的:了解海洛因依赖者脱毒期间上消化道出血情况。方法:对2000年-2004年上半年在我院住院的病历进行统计。结果:共统计1366例海洛因依赖患者的病历,其中有3·95%在脱毒期出现上消化道出血症状;上消化道出血的发生率在不同日用量、既往有无消化系统疾病、戒断后时间早迟之间差异有显著性(P<0·01);在胃出血与十二指肠出血之间差异亦有显著性(P<0·01);1366例患者采用H2受体阻滞剂防治后仅1例发生上消化道出血。结论:海洛因滥用量大、既往有消化系统疾病以及戒断后时间长的海洛因依赖者脱毒期间易发生上消化道出血症状;尽早给予H2受体阻滞剂防治,对预防上消化道出血的发生非常有效。     

海洛因依赖者脱毒期间发生急性胃穿孔的特点与防治

目的··:总结海洛因依赖者在脱毒过程中发生急性胃穿孔的发病原因、临床特点和防治方法。方法··:对我所1997年1月 -1999年3月收治的32例海洛因依赖者并发急性胃穿孔的临床资料进行回顾性分析 ;结果··:32例患急性胃穿孔的海洛因依赖者中 ,男性31例 ,(占96.8 %),女性1例 (占3.1 % );采用自然戒断法 (冷火鸡法 )脱毒者27例(占84.3 %);既往有胃病史者25例(占78.1 %);脱毒1周内发病者31例(占96.8 %);日滥用量>0.6g发病者28例(占87.5 %) ;吸毒年限1.9 -3a发病者26例(占81.3 %);采用烫吸 +静脉注射 +肌肉注射吸毒方式发病者30例(占93.7 %)。结论··:既往有胃病史的男性海洛因依赖者 ,采用自然戒断脱毒法的1周内最容易发生急性胃穿孔 ;急性胃穿孔的发生与海洛因滥用量、吸毒时间和吸毒方式有一定的关系 ;建议对上述患者应采用药物脱毒且适当延长脱毒时间     

丁丙诺啡舌下片在家庭脱毒中疗效观察

目的:评价盐酸丁丙诺啡舌下片(BHS)用于门诊海洛因依赖者急性脱毒期家庭脱毒治疗的疗效及不良反应。方法:对愿意接受本疗法的门诊海洛因依赖者214例采取无对照开放试验,分轻、中、重三组实行家庭脱毒治疗10～12天,记录用药前和脱毒期间戒断症状分和不良反应。结果:132例在10～12天控制急性戒断症状良好,15天脱毒成功率为62%。结论:BHS能有效控制海洛因依赖家庭脱毒期间的急性戒断症状,治疗剂量容易掌握,药源充足,不良反应少而轻、价格低廉。     

海洛因依赖者脱毒期间哮喘发作临床分析

目的：探讨海洛因依赖者脱毒期间哮喘发作的临床特点，为防治提供科学依据。方法：对本院2004年5月至2006年5月收治的3504例海洛因依赖者进行回顾性分析。结果：海洛因依赖者脱毒期间有42例哮喘发作，患病率为12％。其中轻度发作24例（57％）；中度发作16例（39％）；重度发作2例（4％）。哮喘多出现在脱毒中期。结论：海洛因依赖者脱毒期间易发生哮喘，与吸食的海洛因纯度、戒断反应、免疫异常、心理因素有明显关系，并相应提出了防治措施。     

米氮平与苯二氮(艹卓)类药物合并美沙酮对海洛因脱毒的对照研究

目的:比较米氮平与苯二氮(艹卓)类药物合并美沙酮治疗对海洛因依赖者脱毒疗效.方法:比较了美沙酮合并米氮平组(37例)和美沙酮合并苯二氮(艹卓)类药物组(37例)在脱毒治疗后一周、治疗后二周戒断症状量表评分、HAMD焦虑量表评分及睡眠障碍的变化情况.结果:两组海洛因依赖者的戒断反应、焦虑症状在脱毒治疗后均显著减轻,米氮平合并美沙酮治疗比苯二氮(艹卓)类药物合并美沙酮治疗对戒断症状和焦虑减轻更明显,并明显改善入睡困难和睡眠浅.结论:米氮平合并美沙酮治疗和苯二氮(艹卓)类药物合并美沙酮治疗均可有效减轻海洛因依赖者的戒断症状,米氮平合并美沙酮的疗效更明显,并可明显改善睡眠障碍.     

56例海洛因与苯二氮类混合依赖者临床分析

目的·· :探讨海洛因与苯二氮类(BZD)混合依赖者的临床特征。方法··:对近年诊治的56例海洛因与BZD类混合依赖者的戒断症状进行分析。结果··:56例中有48例出现急性脑病综合征 ,发生率85.7%。开始发生时间为入院后的3 -8d ,平均5.0d±sl.5d。结论··:混合滥用给依赖者带来更为严重的戒断症状。海洛因与BZD多药滥用者脱毒时 ,应先戒海洛因 ,再戒BZD。     

麻醉辅助脱毒

阿片类拮抗剂应用于阿片类药物依赖和戒断的研究发现 ,用阿片类拮抗剂可使戒断症状缩短至 4～ 6小时 ,迅速完成脱毒过程。但戒断症状严重 ,并可伴有严重的全身反应 ,麻醉辅助脱毒 (Anesthesia-assisted Opiate Detoxifica-tion)是指用麻醉方法保护阿片类药物依赖者在完成脱毒过程中避免感受戒断症状 ,减轻全身反应 ,从而顺利完成脱毒过程的方法。根据麻醉方法的不同 ,又包括有快速脱毒技术 (RapidOpioid Detoxification,ROD)、超快速脱毒技术 〔1〕 (Ultra Rapid Opioid Detoxification,UROD)。它适用于所有阿片类药物依赖者 :海洛因…     

阿米替林治疗海洛因依赖40例观察

目的:探讨阿米替林辅助美沙酮治疗海洛因依赖的临床疗效。方法:使用阿米替林对40例使用美沙酮的海洛因依赖者进行辅助治疗,剂量为150mg/d,疗程14天。采用自制的戒断症状量表评估疗效。结果:经阿米替林治疗后海洛因依赖者的戒断症状有明显的减轻。结论:阿米替林是一种良好的戒毒辅助用药,能有效缓解戒毒期间的戒断症状,提高了戒断者的依从性,因而增加了脱毒成功率,值得推广。     

十复生胶囊对海洛因依赖者脱毒的临床研究

目的 :观察复方中药十复生胶囊控制海洛因依赖者戒断症状及不良反应。方法 :采用开放实验对 71例海洛因依赖者使用十复生胶囊。结果 :在用药 4日后 ,出现戒断症状的病人明显减少 (占 84.51 % ) ,用药 1 0日后 ,戒断分 <1 0的有 70例 (占 98.59% ) ,在整个用药过程中 ,戒断症状减分率为 0 .50± s0 .1 7;用药期间病人因脱毒引起的焦虑明显降低 ;用药后出现口干、腹泻等不良症状的病人所占的百分率分别为 9.9%和 8.5% ,而其它的不良症状没有出现。结论 :十复生胶囊控制海洛因依赖者的戒断症状 ,其疗效明显 ,比较安全可靠 ,有一定的临床价值。     

中度海洛因依赖者肝肾损害及其危险因素分析

目的：分析中度海洛因依赖者肝、肾功能损害及其危险因素。方法：将最近1周每日平均吸食海洛因量〈2．0g、戒断症状评分总分为65～140分的中度海洛因依赖者纳入研究，回顾性分析1455例肝功能和1407例肾功能指标及影响因素。结果：肝功能指标异常率分别为ALT45．43％、AST38．63％、TBil 17．11％；肾功能指标异常率为BUN6．25％、Cr4．12％。多重Logistic回归分析显示：ALT异常的危险因素是性别、滥用时间和途径，OR分别为0．653、1．150和2．263；AST异常的危险因素是性别、滥用途径，OR分别为0．692、2．447。结论：中度海洛因依赖者的肝损害程度大于肾损害；滥用时间较长者ALT异常的风险较高，男性患者和静脉途径给药引起ALT和AST异常的风险高于女性患者和其他给药途径。     

褪黑素对海洛因依赖大鼠的作用

目的 :观察褪黑素 (MT)对海洛因 (Her)依赖大鼠的作用。方法 :将 15 0只大鼠随机分为海洛因依赖模型组、海洛因依赖MT保护组和溶媒对照组。分别用海洛因、海洛因加MT或溶媒处理大鼠。 4 2d后将海洛因模型组大鼠随机分为MT治疗组、美沙酮治疗组、海洛因依赖组、自然戒断组、纳洛酮催促戒断组。然后观察自然戒断或ip纳洛酮催促戒断症状 ;进行淋巴细胞增殖反应和亮氨酸脑啡肽 (L -EK)以及β内啡肽 (β -EP)的测定。结果 :MT保护组及MT治疗组均显示 :MT可缓解大鼠的戒断症状 ;促进海洛因依赖大鼠脾淋巴细胞增殖 ;提高海洛因依赖大鼠脑L -EK和 β-EP水平。 结论 :MT可部分控制海洛因依赖大鼠的戒断症状 ;对海洛因造成的细胞免疫功能低下可能有预防和逆转的作用     

Acute heroin abstinence in man: I. Changes in behavior and sleep

The purpose of this study was to examine overt behavioral characteristics and sleep during acute heroin abstinence in man. Both heroin-dependent patients and drug-free control subjects were observed and monitored on a 24-hour per day basis for 5 to 7 days. Observational data were analyzed for frequency of occurrence of various behaviors including the signs and symptoms of withdrawal. Electroencephalographic (EEG) data were scored into awake and sleep stages according to standard techniques. The heroin-dependent subjects generally displayed a higher number of observations across all recording days as compared to the controls. In addition, the signs and symptoms of withdrawal for these patients peaked on day 1 or day 2 and then declined over the remaining recording days. The EEG state data showed an increase in waking and decrease in both slow wave and REM sleep during acute heroin withdrawal. Total sleep was maximally suppressed on withdrawal days 2 and 3 and was still below normal control values on withdrawal days 5–7. REM sleep was more disrupted than slow-wave sleep during withdrawal from heroin. Results of this study indicate that heroin withdrawal produces a differential action upon central nervous system structures responsible for the various states of sleep, waking and related behaviors.     

Randomized clinical trial examining duration of voucher-based reinforcement therapy for cocaine abstinence

Background

This is the first study to systematically manipulate duration of voucher-based reinforcement therapy (VBRT) to see if extending the duration increases abstinence during and following VBRT.

Methods

We randomized cocaine-dependent methadone-maintained adults to Standard (12 weeks; n = 62) or Extended (36 weeks; n = 68) VBRT and provided escalating voucher amounts contingent upon urinalysis verification of cocaine abstinence. Urinalysis was scheduled at least every 2 weeks during the 48-week study and more frequently during VBRT (3/week) and 12 weeks of Aftercare (2/week).

Results

Extended VBRT produced longer durations of continuous cocaine abstinence during weeks 1–24 (5.7 vs 2.7 weeks; p = 0.003) and proportionally more abstinence during weeks 24–36 (X² = 4.57, p = .03, OR = 2.18) compared to Standard VBRT. Duration of VBRT did not directly predict after-VBRT abstinence; but longer continuous abstinence during VBRT predicted abstinence during Aftercare (p = 0.001) and during the last 12 weeks of the study (p < 0.001). Extended VBRT averaged higher monthly voucher costs compared to Standard VBRT ($96 vs $43, p < .001); however, the average cost per week of abstinence attained was higher in the Standard group ($8.06 vs $5.88, p < .001). Participants in the Extended group with voucher costs exceeding $25 monthly averaged 20 weeks of continuous abstinence.

Conclusions

Greater abstinence occurred during Extended VBRT, but providing a longer duration was not by itself sufficient to maintain abstinence after VBRT. However, if abstinence can be captured and sustained during VBRT, then providing longer durations may help increase the continuous abstinence that predicts better long-term outcomes.     

The relationship between abstinence for one year following pretreatment assessment and alcohol use and other functioning at two years in individuals presenting for alcohol treatment

OBJECTIVE: The purpose of this study was to replicate and extend research that shows abstinence from alcohol during the first year following treatment predicts better longer term functioning in alcohol use and other areas. METHOD: The subjects were 187 men and women who had participated in a clinical trial of the differential effectiveness of two behavioral treatments for alcohol problems as a function of subject characteristics. All subjects who participated in this phase of the study were classified as either abstinent from alcohol or not based on their drinking behavior during the first 12 months following treatment initiation. Subjects' alcohol use and other behaviors were evaluated for Months 13-24. The primary dependent variables of interest were alcohol use, self-efficacy, and psychological functioning. RESULTS: A comparison of the two abstinence groups showed that abstainers, compared to drinkers, had less alcohol use, higher self-efficacy, and better psychological functioning. CONCLUSIONS The results suggest the association is robust between abstinence during the first year following treatment initiation or cessation and later functioning, and extend this finding to include psychological functioning. Future research should focus on possible mediators of the abstinence correlations with later behavior that are of theoretical and practical importance, and on specifying gradients of duration of abstinence or other drinking patterns reflecting improvement and their relationship to longer term functioning.     

丁丙诺啡舌下含片与美沙酮用于海洛因依赖门诊稽延期治疗的对照研究

目的观察丁丙诺啡舌下含片与美沙酮用于海洛因依赖者稽延期治疗的价值。方法对完成脱毒治疗患者，依先后次序交叉纳入观察组与对照组，分别给予丁丙诺啡舌下含片和美沙酮治疗6个月，观察操守时间，并于人组前后做焦虑量表评分。结果丁丙诺啡舌下含片组比美沙酮组的操守时间长（P〈0．01），焦虑评分低（P〈0．05）。结论丁丙诺啡舌下含片于海洛因依赖门诊稽延期治疗能更好地缓解焦虑情绪并延长操守时间。     

Opioid reinforcement in heroin-dependent volunteers during outpatient buprenorphine maintenance.

This study examined the reinforcing effects of hydromorphone (HYD) (0, 4, 8, and 16 mg/70 kg i.m.) in heroin-dependent outpatient volunteers maintained on buprenorphine (BUP) at doses of 2, 4, and 8 mg, each for 2 weeks. Following a week of maintenance at each dose, volunteers received injections of one of the four HYD doses under double-blind conditions. Eight volunteers (abstainers) were heroin-free during HYD test weeks, whereas six volunteers remained heroin-positive (nonabstainers). Among abstainers, HYD had minimal reinforcing value, whereas in nonabstainers there were marked dose-related increases in HYD reinforcing value, which were not attenuated by increasing doses of BUP. A similar pattern was found for HYD subjective agonist effects. Heroin craving among nonabstainers was significantly higher compared with abstainers, and was reduced in a dose-related manner by HYD. Although BUP and HYD produced dose-related miosis, abstinence status had no differential effect. In summary, BUP effects on opioid reinforcement were consistent from outpatient setting (heroin abstinence) to laboratory setting (decreased HYD reinforcement), supporting the validity of this laboratory model.     

Inferior Frontal Cortex Modulation with an Acute Dose of Heroin During Cognitive Control

Impairments in inhibitory control and in stimulus-driven attention are hallmarks of drug addiction and are associated with decreased activation in the right inferior frontal gyrus (IFG). Although previous studies indicate that the response inhibition function is impaired in abstinent heroin dependents, and that this is mediated by reduced IFG activity, it remains completely unknown whether and how an acute dose of heroin modulates IFG activity during cognitive control in heroin-dependent patients. This study investigates the acute effects of heroin administration on IFG activity during response inhibition and stimulus-driven attention in heroin-dependent patients. Using a cross-over, double-blind, placebo-controlled design, saline and heroin were administered to 26 heroin-dependent patients from stable heroin-assisted treatment, while performing a Go/No–Go event-related functional magnetic resonance imaging task to assess right IFG activity during motor response inhibition, as well as during oddball-driven attention allocation. Relative to saline, heroin significantly reduced right IFG activity during both successful response inhibition and oddball-driven attention allocation, whereas it did not change right IFG activity during response inhibition after correction for the effect of attention allocation. These heroin-induced effects were not related to changes in drug craving, state anxiety, behavioral performance, or co-consumption of psychostimulant drugs. This study demonstrates that heroin administration acutely impairs stimulus-driven attention allocation, as indicated by reduced IFG activity in response to infrequently presented stimuli, and does not specifically modulate IFG activity during response inhibition.