小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 阿片使用的不良反应
- 高成瘾严重指数(ASI)得分
- 阿片致欣快作用降低
- 瞳孔缩小
- 瞳孔放大
- 浅/慢呼吸或窒息
- 针孔、瘢痕或注射处皮肤坏死
- 意识不清
- 脉搏小于40次/分
其他诊断因素
- 慢性便秘
- 体重减轻
- 恶心/呕吐
- 镇静
- 睡眠不稳/失眠
- 记忆损害
- 喷嚏
- 打哈欠
- 腹部绞痛
- 腹泻
- 背痛/肌肉痉挛
- 忽冷忽热
- 低血压
- 镇静
- 意识模糊
- 言语不清
- 攻击行为
- 过度出汗或流泪
- 鼻溢(流涕)
- 多动
- 毛发竖立
- 呼吸急促
- 高血压
- 心律失常
- 惊厥
危险因素
- 男性
- 低龄
- 精神障碍既往史
- 物质滥用既往史
- 长期的阿片治疗
- 物质滥用家族史
诊断性检查
首要检查
- 尿液药物筛查
- 气相色谱-质谱联用技术(GC-MS)
- 血清电解质
- 全血细胞计数 (FBC)
- 尿素/肌酐
- 肝功能检查 (LFT)
- 快速血浆反应素检测
- 肝炎血清学
- HIV 血清学
- PPD皮试
- 血液培养
- Β-hCG
治疗流程
非孕期成人患者的门诊/住院脱毒计划
非孕期青少年患者住院/门诊脱毒计划
孕妇住院/门诊脱毒计划
非孕期成人患者脱毒后治疗计划
非孕期青少年脱毒后治疗计划
孕妇脱毒后治疗计划
撰稿人
作者
Ashwin A. Patkar, MD, MRCPsych
Associate Professor
Medical Director
Duke Addictions Program
Department of Psychiatry and Behavioral Sciences
Duke University Medical Center
Durham
NC
利益声明
AAP is a consultant/member of the advisory board for Cubist Pharma, Biodelivery Sciences (BDSI), Kaleo, Forest Research Institute, and Titan Pharma; is on the speaker’s bureau and received honoraria from Otsuka, Alkermes, Sunovion, and BDSI; and is a shareholder in Ironwood Sciences LLC and Patkar Medical Consultants. AAP's institution has received grant support from National Institutes of Health (NIDA, NIAAA), SAMHSA, AstraZeneca, Bristol-Myers Squibb, Cephalon, Daiichi Sankyo, Envivo Pharma, Forest, J & J, Jazz Pharmaceuticals, Lundbeck, Merck, Organon, Pfizer, Sunovion, Shire, and Titan. AAP holds unpaid positions on the Board of Directors of Southlight Inc, the Board of Advisors of People's Medical Care, the Executive Committee of Triangle Indian American Physicians Society, and also as President of Indo American Psychiatric Association.
Jonathan C. Lee, MD
Medical Director
The Farley Center at Williamsburg Place
Williamsburg
VA
Affiliate Assistant Professor
Department of Psychiatric Medicine
East Carolina University
Greenville
NC
Community Assistant Professor
Department of Family Medicine
Eastern Virginia Medical School
Norfolk
VA
利益声明
JCL is a full-time employee at The Farley Center at Williamsburg Place.
Douglas M. Burgess, MD
Assistant Professor
Department of Psychiatry
University of Missouri - Kansas City
Medical Director
Outpatient Behavioral Health
Truman Medical Centers
Kansas City
MO
利益声明
DMB declares that he has no competing interests.
鸣谢
Dr Ashwin A. Patkar, Dr Jonathan C. Lee, and Dr Douglas M. Burgess would like to gratefully acknowledge Dr Kamal Bhatia and Dr Srilakshmi Musham, previous contributors to this monograph. KB declares that he has received grant support from National Institutes of Health, Lundbeck Pharmaceuticals, Pfizer, and Titan Pharmaceuticals. SM declares that she has received grant support from Pfizer, Titan Pharmaceuticals, Shire Pharmaceuticals, and the Forest Research Institute.
同行评议者
Andrew Stolbach, MD
Assistant Professor
Department of Emergency Medicine
Johns Hopkins University Hospital
Baltimore
MD
利益声明
AS declares that he has no competing interests.
F. Gerard Moeller, MD
Professor
Department of Psychiatry and Behavioral Sciences
University of Texas
Health Science Center
Houston
TX
利益声明
FGM declares that he has no competing interests.
Christos Kouimtsidis, MBBS, MSc, MRCPsych, PhD
Consultant Psychiatrist and Honorary Senior Lecturer
Institute of Psychiatry
King's College London
London
UK
利益声明
CK declares that he has no competing interests.
鉴别诊断
- 酒精中毒
- 镇静剂中毒
- 抗胆碱能药物中毒
更多 鉴别诊断指南
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- TIP 63:阿片类物质使用障碍的药物治疗
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