韩氏穴位神经刺激仪治疗阿片戒断综合征的临床研究

HAN′S ACUPOINT NERVE STIMULATOR(HANS)FOR THE TREATMENT OF OPIATE WITHDRAWAL SYNDROME

根据电针刺激可促使中枢神经系统释放内源性阿片肽的原理，应用韩氏穴位神经刺激仪（ＨＡＮＳ），每天刺激一次，每次３０分钟，治疗阿片成瘾者的戒断综合征。首次治疗后便可使过高的心率下降，产生温热感和欣快感，并可使烦躁不安的患者转入睡眠状态，缓解戒断症状。４～５天即可消除“心慌”，明显增加体重，７～１０天可使阿片成瘾者完全脱瘾。在所进行试验的三种频率（２Ｈｚ、２／１００Ｈｚ、１００Ｈｚ）中，依其有效程度依次为２／１００Ｈｚ＞２Ｈｚ≈１００Ｈｚ。单独应用ＨＡＮＳ有明显的临床效果，如与其它药物合并应用，可减少替代药物的用量，进一步缩短戒毒疗程。是否能用ＨＡＮＳ防止复吸，有待进一步研究。

In a previous study(Drug Alcohol Dependence 1993,31:169)we have shown that naloxone-induced morphine abstinence syndrome in rats can be suppressed by electroacupuncture(EA)of 2Hz or 100Hz,Since EA or TENS of 2Hz isknown to release central β-endorphin and enkephalin,and that of 100Hz to release dynorphin in the spinal cord(News Physiol Sci 1992,7:176),the effectiveness of 100Hz stimulation may suggest the involvement of dynorphin in this event.In the present study a special TENS device,Han's Acupoint Nerve Stimulator,HANS,was used to treat 212 heroin addicts(161 male,51 female,aged 15-38) subjected to abrupt abstinence.HANS was used 30 min per day from day 1 to day 10.Two pairs of skin electrodes were placed on Heku point on one hand and Neiguang point on the other forearm. Frequency of HANS was set at one of the foloowing:2,100,or 2/100(2Hz alternating with 100Hz,each lasting for 3s).Comparison was made by sequential analysis between two groups or by ANOVA between multiple groups.Among the objective indices,the decrease of heart rate was most obvious,which returned from 110/min to normal level within 4-5 days of HANS treatment,whereas in the control group receiving placebo electrodes,the tachycardia remained for at least 10 days.Comparison of different frequencies revealed:(1)Overall clinical effec,2/100>2=100Hz;(2)Suppression of tachycardia,2/100>2=100Hz;(3)Euphoria-like effect,2100>100=2Hz;(4)Warm feeling,2/100>2>100Hz;(5)hypnotic effect,2/100>100=2Hz;(6)Increase of body weight,2=100=2/100Hz >control group.It is thus obvious that HANS was effective in relieving the opiate withdrawal syndrome,and2/100Hz seems to be the most favorable frequency.It is interesting to mention that 2/100Hz has also been shown to be the most effective frequency to induce analgesia in rats and in humans.A synergistic effect between enkephalin and dynorphin(in the case of 2/100Hz stimulation) may underlye this interesting clinical finding.It is anticipated that HANS may also be useful to prevent recurrence of drug use after the abstinence.