丁丙诺啡舌下片用于海洛因依赖脱毒治疗的临床研究

目的 研究盐酸丁丙诺啡舌下片对于海洛因依赖脱毒治疗的临床疗效及不良反应.方法 根据戒断症状的严重程度、吸毒剂量、方式等给予不同的盐酸丁丙诺啡舌下片观察其疗效及不良反应.结果 脱毒治疗前后比较戒断症状评分差异有统计学意义(P＜0.01),不良反应轻微.结论 盐酸丁丙诺啡舌下片可用于海洛因依赖的早期脱毒治疗、不良反应轻微.     

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。     

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。     

丁丙诺啡舌下含片临床药理研究进展

丁丙诺啡为蒂巴因的衍生物 ,2 0世纪 6 0年代由英国药物学家合成 ,其注射液用于镇痛。 70年代中期研制舌下含片。 80年代盐酸丁丙诺啡作为镇痛药在许多国家登记注册用于临床 ,主要用于手术中镇痛。丁丙诺啡舌下含片治疗海洛因依赖的Ⅰ、Ⅱ期临床试验始于 70代末和 80年代初。早期的临床试验主要是在少数病人中用较低的剂量进行的简单的治疗研究 ,被认为是治疗海洛因依赖很有希望的药物。 80年代中期 ,越来越多的报道表明丁丙诺啡可减缓海洛因依赖的戒断症状。80年代后期 ,出现了丁丙诺啡舌下含片与美沙酮对照用于阿片类依赖维持治疗的大样本…     

丁丙诺啡和美沙酮对海洛因依赖者脱毒治疗的临床实验研究比较

丁丙诺啡和美沙酮对海洛因依赖者脱毒治疗的临床实验研究比较比较了丁丙诺啡和美沙酮对海洛因依赖的门诊病人脱毒治疗的效果。４５位病人随机分为两组：一组舌下含服丁丙诺啡，另一组口服美沙酮。采用双盲、双模拟对照实验设计，研究丁丙诺啡在一个９０ｄ的脱毒治疗程序中...     

美沙酮、丁丙诺啡治疗海洛因依赖临床对照研究

目的:比较美沙酮和丁丙诺啡控制海洛因依赖戒断症状的疗效及不良反应的差异。方法:56例入组病例按入院时间先后顺序随机分为美沙酮组(23例)和丁丙诺啡组(33例),观察8d,比较两药的疗效和不良反应。结果:丁丙诺啡组d1,d5,d6的戒断症状均分高于美沙酮组(P<0.01,P<0.05),两组单项戒断症状比较,美沙酮组呕吐、哈欠、流泪、流涕重于丁丙诺啡组(P<0.05)。而丁丙诺啡组困倦、厌食显著重于美沙酮组(P<0.01),骨肌肉疼痛、卷曲姿势、焦虑、激动不安重于美沙酮组(P<0.05),丁丙诺啡组住院时间比美沙酮组短(P<0.01)。美沙酮主要药物副作用为恶心呕吐,丁丙诺啡主要副作用为急性尿潴留。结论:美沙酮脱毒效能较为理想,丁丙诺啡能够完成脱毒疗程,但存在某些不足之处。     

益安回生口服液联合丁丙诺啡治疗海洛因依赖疗效观察

目的:观察丁丙诺啡 益安回生口服液在海洛因依赖脱瘾治疗中的疗效,探索疗效好,不造成新药瘾的脱毒脱瘾方案。方法:将90例海洛因依赖患者随机分为A、B两组。A组给予丁丙诺啡舌下片 益安回生口服液。B组给予丁丙诺啡舌下片 安慰剂,对照组观察两组的脱瘾疗效。结果:两组戒断症状记分差异有非常显著性意义(P<0.01)。A组在焦虑、肌肉骨骼疼痛、失眠的分级明显优于B组。结论:益安回生口服液与丁丙诺啡舌下片联用能更有效的缓解戒断症状。     

参附脱毒胶囊联合丁丙诺啡舌下片治疗海洛因依赖的临床疗效观察

目的 :探索戒毒疗效好、不造成新的药物成瘾 ,且经济的脱毒方案。方法 :将 80例海洛因依赖者分成A、B两组 ,A组给予参附脱毒胶囊联合丁丙诺啡脱毒 ,B组单纯使用小剂量美沙酮脱毒 ,对照观察两组的脱毒疗效。结果 :在控制戒断症状方面 ,A组与B组比较差异无显著性 (P >0 0 5 ) ,但A组不良反应轻微 ,B组有 2 3例停药后有索药行为。两药合用 ,参附脱毒胶囊用量减少。结论 :参附脱毒胶囊联合丁丙诺啡临床疗效可靠 ,无成瘾性 ,不良反应少 ,经济 ,值得推广使用     

尼莫地平控释片辅助治疗海洛因戒断综合征

目的··:观察钙拮抗剂尼莫地平控释片对海洛因戒断综合征的辅助治疗作用。方法··:治疗组30例 ,采用美沙酮、丁丙诺啡梯度替代递减法治疗 ,同时口服尼莫地平控释片60mg,每天2次。对照组单纯使用美沙酮、丁丙诺啡梯度替代递减法治疗 ,10d为一疗程。结果··:治疗期间治疗组戒断症状评分较低 ,尤其是d4两组戒断症状评分有显著性差异(P<0.05),两组焦虑症状 ,脱毒率及美沙酮、丁丙诺啡平均用量无显著性差异。结论··:尼莫地平控释片对海洛因戒断症状有一定辅助治疗作用 ,尤其对忽冷忽热、腹痛、周身疼痛不适、心悸胸闷等戒断症状控制较好 ,可在临床实践中进一步总结应用     

盐酸丁丙诺啡对海洛因依赖者脱毒后预防复吸的研究—248例盐酸丁丙诺啡维持治疗临床研究

目的:研究盐酸丁丙诺啡对海洛因依赖者脱毒后预防复吸的效能。方法:248例海洛因依赖者完成脱毒后给予盐酸丁丙诺啡舌下含片维持治疗,药物剂量从第1月4mg·d-1,2mg·d-1到第2月后一直以1.5mg·d-1维持;维持者每次来所取药时做尿液吗啡检测,填写相关量表。结果:丁丙诺啡舌下含片维持治疗第1,3,6,12,18,24月时的保持率分别为61·69%,29·84%,12·10%,2·65%,1·61%和0·81%。尿液吗啡检测阴性率在前2个月占应检人数的75%以上;渴求强度“非常想”和“不想”因子在第1,6,12月时差异有显著性(P<0·01);稽延性戒断症状总平均分第1月和第3,6,12月比较差异有显著性(P<0·01);不良反应以思睡、便秘为主,后者随维持治疗时间延长而加重。结论:盐酸丁丙诺啡舌下含片维持治疗对海洛因依赖者脱毒后预防复吸有肯定的作用。     

Efficacy of buspirone in the treatment of opioid withdrawal

In an attempt to develop a new opiate detoxification approach, the authors assessed the efficacy of buspirone in the treatment of acute heroin withdrawal. Buspirone, a drug interacting with the serotonergic system, was selected because there is evidence that a decrease in serotonergic neurotransmission may be involved in opiate withdrawal symptoms. Twenty-nine hospitalized heroin addicts were randomized to 4 groups: (1) placebo; (2) methadone; (3) buspirone 30 mg daily; (4) buspirone 45 mg daily. The double-blind trial started in all patients with a 5-day methadone stabilization period ending with a 30-mg dose. This was followed from days 6 through 12 by placebo in group 1 and by a methadone taper in group 2. Because of its delayed action, buspirone was started on day 1 in groups 3 and 4 and was continued, after methadone discontinuation, through day 12. On day 13, drugs and placebo were discontinued and patients were observed through day 14. Withdrawal symptoms were assessed with the "Subjective Opiate Withdrawal Scale" (SOWS) and the "Objective Opiate Withdrawal Scale" (OOWS). The SOWS and OOWS scores were significantly higher in the placebo group than in the methadone, buspirone 30 mg, and buspirone 45 mg groups. There were no significant differences in SOWS or OOWS scores when the methadone group was compared with each of the two buspirone groups or when the two buspirone groups were compared with one another. In conclusion, buspirone, a nonopiate drug with no abuse potential, a safe side effect profile and no withdrawal symptoms, at doses of 30 and 45 mg, was as effective as a methadone taper in alleviating the withdrawal symptoms of heroin addicts stabilized for 5 days with, and then withdrawn from, methadone. The use of buspirone could be particularly helpful in outpatient settings where the duration of the methadone taper recommended for detoxification can be lengthy.     

Cessation of methadone maintenance treatment using buprenorphine: transfer from methadone to buprenorphine and subsequent buprenorphine reductions

BACKGROUND: Buprenorphine is used in the treatment of opioid dependence. Due to its pharmacology, the transfer from methadone to buprenorphine may precipitate withdrawal symptoms. METHODS: Methadone maintained patients with clinical indicators of stability who were seeking withdrawal from methadone were recruited from three Australian states. Patients on methadone doses between 30 and 40 mg were randomised to transfer to buprenorphine by a fixed dose (transfer at 30 mg methadone) or by a variable dose induction (transfer when 'uncomfortable'). A third group of patients with methadone doses less than 30 mg were transferred to buprenorphine at their entry methadone dose. Fifty-one patients were inducted onto buprenorphine using the same dosing protocol with the first dose of 4 mg buprenorphine. Following stabilisation on buprenorphine, patients gradually reduced the buprenorphine dose to 0 mg. Withdrawal severity and drug use was monitored. RESULTS: There were no significant difference between the transfer at 30 mg and transfer when 'uncomfortable' dosing protocols in severity of withdrawal on transfer from methadone to buprenorphine. Those on doses less than 30 mg reported significantly less withdrawal discomfort at transfer. All but one patient stabilised on buprenorphine. Thirty-eight of the 51 patients inducted onto buprenorphine reached 0 mg. CONCLUSIONS: Transfer from methadone to buprenorphine can safely occur from doses of around 30 mg of methadone. Buprenorphine dose reductions were well tolerated. Thirty-one percent of patients were not using heroin or methadone at 1-month follow-up.     

头针治疗海洛因依赖者戒断症状94例的临床研究

目的:比较头针 美沙酮、体针 美沙酮、单纯美沙酮疗法对改善海洛因依赖者脱毒期戒断症状的临床疗效,为今后头针参与戒毒治疗,降低复吸率进行积极的探索。方法:对94例海洛因依赖者用上述三种疗法治疗,随机分为三组,动态观察10天的戒断症状。使用戒断症状量表观察脱毒的疗效。结果:治疗10天后评分显示:头针组控制戒断症状的效果最为完全,体针组也有一定的效果,但不及头针组,两组比较有统计学意义(P<0.01)。两组针刺组的治疗效果均好于单纯美沙酮组(P<0.01)。在脱毒期失眠、焦虑症状的改善方面,头针组和其它两组比较表现出明显的优势(P<0.01)。在脱毒期躯体症状的改善方面,头针组和体针组无统计学差异(P>0.05)。在脱毒期焦虑症状的改善方面,体针组和美沙酮组比较无统计学意义(P>0.05)。结论:头针减轻了海洛因依赖者脱毒期戒断症状,特别是在改善患者的失眠、焦虑等精神依赖方面具有明显的优势,在目前尚无特效的戒毒疗法的情况下,针灸参与戒毒具有疗效肯定、无副作用、经济安全的特点,头针结合药物产生了一定的协同作用。     

Accelerated lofexidine treatment regimen compared with conventional lofexidine and methadone treatment for in-patient opiate detoxification

This open study compares an accelerated 5-day lofexidine regimen with orthodox 10-day lofexidine and methadone regimens in the treatment of opiate withdrawal in 61 polysubstance abusing opiate addicts. Significant differences in levels of withdrawal symptoms were found on days 11, 13–15 and 17–20, symptoms resolving most rapidly in the 5-day lofexidine treatment group, whilst withdrawal responses in the 10-day lofexidine treatment group were intermediate between the 5-day lofexidine and standard methadone treatment conditions. When the two lofexidine regimens were separately compared with methadone the 5-day lofexidine treatment was significantly more effective on day 10, 11 and 13–20, whilst the 10-day lofexidine treatment was not significantly different from methadone. There were no significant differences in rates of completion of detoxification between the three treatments. Both the lofexidine treatment regimens had a similar effect on blood pressure. Five patients experienced side effects which resolved with dose reduction, all remaining in the study. An accelerated 5-day lofexidine regimen may attenuate opiate withdrawal symptoms more rapidly than conventional 10-day lofexidine or methadone treatment schedules without exacerbating hypotensive side effects.     

Rapid heroin detoxification using a single high dose of buprenorphine

To test the effect of 32 mg of buprenorphine on the withdrawal process from heroin, 10 street-heroin using subjects were given 32 mg of sublingual buprenorphine, following heroin abstinence of 24 hours. Withdrawal symptoms were monitored during the first few hours, and followed for six days after buprenorphine administration, after which naltrexone (50 mg) was introduced to prevent future heroin use. Nine subjects completed detoxification with negligible withdrawal symptoms and a smooth transition to naltrexone. One subject was excluded from the study due to methadone ingestion prior to experiment. These results strongly suggest that painless detoxification from heroin can be obtained by a single high dose of buprenorphine.     

丁丙诺啡递减疗法治疗海洛因依赖患者480例临床疗效比较

分别采用１０ｄ递减法和５ｄ递减法用丁丙诺啡对４８０例患者进行戒毒治疗，结果表明：该药治疗期间病人戒断症状控制平稳，撤药反应轻微，未发现丁丙诺啡依赖形成。两种递减法比较结果显示，对于重度依赖患者，１０ｄ疗法优于５ｄ疗法；对于中度和轻度依赖患者，两种疗法无显著性差异；１０ｄ疗法脱毒成功率明显高于５ｄ疗法，二者差异具有显著性意义（Ｐ＜０．０５）。治疗中副作用主要有头痛、疲乏、偶发晕厥。治疗后部分患者出现顽固性失眠等稽延性戒断综合征，这可能是部分依赖患者复吸原因之一。本文结果证明丁丙诺啡是一种安全有效的海洛因依赖治疗药，且采用１０ｄ递减法给药具有更好疗效。     

Buprenorphine: an alternative to methadone for heroin dependence treatment.

Eighty-five heroin addicts who were unwilling to receive methadone maintenance or enter therapeutic communities were assessed, single-blind, for the lowest sublingual dose of buprenorphine that blocked heroin craving (8.0 mg max). All doses were administered daily under observation. After maintenance for 4 to 12 weeks, abstinent subjects (confirmed by urine drug screens) entered a double-blind discontinuation trial and were randomly assigned to receive dose reductions (10% twice weekly for 5 weeks to zero dose, then placebo for 2 weeks) or a stable dose for 7 weeks. Subjects were terminated from discontinuation if heroin was used or they had increased craving/symptoms. Subjects completed the trial if they did not use heroin and had no increase in craving/symptoms. A wide dose range (1.5-8.0 mg/day) was effective in reducing heroin craving and use. Of 73 subjects who received buprenorphine for 4 to 52 weeks, 40 had no prior treatment, despite high levels (mean $/day heroin = 70.5 +/- 94.7) and many years (mean years = 10.7 +/- 8.6) of dependence. Subjects who received dose reductions developed abstinence symptoms, low energy most commonly, associated with drug-seeking behavior. Discontinuation trial outcome (n = 51) shows a highly significant difference between 29 subjects who received dose reductions (28 terminated, 1 completed) and 22 subjects who received no dose reductions (3 terminated; 19 completed) (chi-square = 36.08; p less than .00001). The findings suggest that buprenorphine could be an important medication for reducing demand for heroin by many heroin addicts who remain outside the present health-care system.(ABSTRACT TRUNCATED AT 250 WORDS)     

益安口服液用于海洛因依赖者脱毒Ⅳ期临床评价

目的·· :评价益安口服液治疗海洛因依赖的戒断症状及稽延性戒断症状的效果及不良反应。方法··:固定疗程、固定剂量的多中心Ⅳ期临床开放实验。海洛因中度依赖者单纯使用益安口服液 ;重度依赖者 ,前3d与美沙酮联合用药。疗程为10d。稽延性戒断症状的治疗于脱毒后d10开始 ,疗程30d ;稽延性戒断症状于用药后每5d测评一次。结果··:单独使用益安口服液组 (495例 )和与美沙酮联合组 (75例 )用药后每日戒断症状总分与各自用药前比较 ,差异有显著性(P<0.01) ;稽延性戒断症状治疗组 (109例 )每次测评稽延性症状总分与用药前相比明显下降 ,差异有显著性 (P<0.01)。益安口服液的不良反应主要有口干、腹泻、食欲不振、恶心等胃肠道反应 ,一般表现较轻 ,药物减量即可缓解。结论·· :益安口服液能有效地控制海洛因依赖者的戒断症状 ;治疗稽延性戒断症状效果肯定 ;不良反应小 ,是一安全的戒毒中药制剂     

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