盐酸纳曲酮预防阿片成瘾者复吸的流行病学调查  

AN INVESTIGATION ON EFFICACY OF NALTREXONE THERAPY FOR RELAPSE PREVENTION AFTER DETOXIFICATION IN HEROIN ADDICTS

作　　者：刘志民[1] 连智[1] 孙桂宽[1] 鲍彦平[1] 李晓东[2] 宋森林 刘锐克[1] 

机构地区：[1]北京大学中国药物依赖性研究所,北京100191 [2]广东珠海瑞桦戒毒康复中心,珠海519070 [3]北京大兴戒毒治疗中心,北京100040

出　　处：《中国药物依赖性杂志》2008年第6期439-444,共6页Chinese Journal of Drug Dependence

基　　金：国家重点基础研究专项(973项目)课题(NO.2003CB515400);国家十一五支撑计划专项课题(NO.2007BAIO7B04)

摘　　要：目的:调查盐酸纳曲酮(NTX)预防海洛因成瘾者戒毒后复吸的效果及其影响坚持服药的因素。方法和对象:应用回顾性调查方法,在广东、北京、浙江(宁波)等三地区进行调查。调查对象入组条件为:(1)使用过NTX;(2)自愿参加调查,依从性较好,有严重身心疾病患者除外。主要调查内容:(1)NTX作为维持用药的效果与可接受性;(2)服药人员中偷吸毒品或复发情况;(3)服药期间滥用海洛因的主观效应;(4)NTX的不良反应分布及发生率。结果:共调查有效服药人员531例,其中广东、北京、宁波分别为438、83和10例。平均NTX使用时间5.1±s7.0(0.3-84)月;平均日使用剂量45.5 mg。39.4%的被调查者在服用NTX期间偷吸海洛因无任何欣快感;在服用NTX前后滥用海洛因的欣快感分别为8.1 cm±s2.2 cm和2.8 cm±s2.5 cm(VAS值)(t值=38.626,P=0.000)。57.6%(306/531)的服药者主诉服药后出现药物不良反应,511例接受过肝功能(GPT)检测者(实际应答GPT值人数为95人)的平均GPT水平为36.2±s26.0单位,其中大于40单位的22人,占有效应答人数的23.2%。对NTX的认知和可接受性调查显示,多数被调查对象(87.2%)表示愿意长期服用NTX。结论:纳曲酮是一个有效的预防海洛因成瘾者戒毒后复发的药物;多数服药人员有希望通过服药预防复发的主观意愿,但也存在障碍/局限持续使用的因素。Objective： To evaluate the efficacy of naltrexone （NTX） as a maintenance pharmacotherapy for relapse prevention treatment in heroin addicts, and the factors influencing NTX use. Methods：A multi -center retrospective investigation was carried out in drug dependent treatment agencies based in the regions of Guangdong, Beijing and Zhejiang. All the subjects were opiate dependent clients and met the following criteria： （ 1 ） had taken NTX regularly on family basis; （2） agreed to participate in this study, and no severe organic diseases or psychiatric disorders. The outcomes of NTX treatment assessed were：（ 1 ） the acceptability and efficacy for maintenance treatment; （2） heroin re -use or relapse during NTX maintenance therapy and the reasons; （3） subjective euphoria associated with heroin use before and during NTX maintenance therapy;（4）presence of adverse reactions of NTX. Results： A total of 531 eligible clients who had the experience of NTX use completed the survey. The mean duration of NTX maintenance therapy was 5. 1 ±s 7.0 （0.3 -84） months. The mean daily dose of NTX was 45.5 mg. 39.4% （209/531） of the clients experienced no any subjective euphoria when they tried to re -use heroin during NTX use. The mean value of subjective euphoria for heroin before and during NTX maintenance therapy by VAS was 8. 1 cm ± s 2. 2 cm and 2. 8 cm ± s 2. 5 cm, respectively （ t = 38. 626; P = 0. 000）. 57. 6% （306/531） had experienced adverse drug effects and 23. 2% （22/95） had their GPT more than 40 unit （ the average 36. 2 ± s 26.0）. The knowledge and acceptance of NTX revealed that 87. 2% would like to take NTX for longtime. Conclusion ：NTX appears to be a prornising pharmaeothempy for relapse prevention in heroin addicts, and particularly in family or community based maintenance therapy in China.

关 键 词：纳曲酮 回顾性调查 阿片类依赖 维持治疗 预防复吸 

分 类 号：R595.5[医药卫生—内科学] R595.505[医药卫生—临床医学]