盐酸纳曲酮对阿片类成瘾脱毒后防止复发效能的再评价──1088例纳曲酮维持治疗临床研究

REAPPRAISAL ON THE EFFICACY OF NALTREXON HYDROCHLORIDE IN PREVENTING REABUSE OF OPIATES AFTER DETOXIFICATION AMONG CHINESE SUBJECTS

目的··:就盐酸纳曲酮防止阿片类成瘾脱毒后复发的效能进行再评价。方法··:1088例完成脱毒治疗的海洛因依赖者给予纳曲酮治疗。药物剂量相对固定在40-50mg·d-1,并随患者反应调整。治疗期间定期门诊或出诊随访。结·果·:服用纳曲酮6个月的保持率为33.4%,与自身同期操守率(2.4%)比较具有显著性差异。服用纳曲酮后,再吸海洛因的欣快感、渴求程度及偶吸海洛因的发生率均降低。纳曲酮的不良反应轻,包括:睡眠障碍、消化系统症状和乏力,少数患者转氨酶呈一过性增高。在纳曲酮治疗的同时给予积极的家庭支持和社会帮教,提供生活和就业技能的指导,减少偶吸的机会等措施,有助于提高服药保持时间。结论··:进一步证实了纳曲酮对预防我国阿片类依赖者脱毒后复吸具有肯定的辅助治疗作用。

Objective: The overall efficacy of naltrexone hydrochloride(NTX)in preventing relapse of heroin addiction was studied among 1088 subjects. Method: A six_month follow up study was carried out and NTX 40-50 mg·d-1 was given at the beginning with titration of daily dosage based on patients' response. Result: The retention rate on NTX at the 6th month period was 33.4%, whereas the previous abstinence rate of the same subjects was only 2.4%. After NTX treatment, the average euphoric effects attenuated, the degree of craving minimized and the rate of lapse of heroin taking was decreased at the end of 6th month. The adverse drug reactions were mild, mainly sleep disorder, gastrointestinal symptoms and fatigue, while laboratory test revealed only minor cases with transient increase of transaminases. The multiple regressive analysis of factors influencing naltrexone treatment shows that positive participation of family members in social support,early training of living skills and coping skill to avoid reabusing drug would benefit the effects of naltrexone in relapse prevention. Conclusion: NTX is an effective adjunct medication in relapse prevention of heroin dependence.