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
- 低龄
- 心理健康障碍病史
- 物质使用史
- 长期的阿片治疗
- 儿童期创伤
- 物质使用家族史
诊断性检查
首要检查
- 尿液或唾液药物筛查
- 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)
- 肝炎血清学
- HIV 血清学
- 纯化蛋白衍生物 (purified protein derivative, PPD) 皮试
需考虑的检查
- 快速血浆反应素试验
- 血培养
- β-人绒毛膜促性腺激素（beta-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 has received payments for being Consultant to Radeas Labs that performs drug testing and is a member of the Speakers Bureau for Janssen Pharmaceuticals, manufacturer of Spravato, and Otsuka Pharmaceuticals, manufacturer of Rexulti. AP is a stockholder in Generys Biopharmaceuticals that has compounds in development for drug addiction.
Jonathan C. Lee, MD
Medical Director
The Farley Center at Williamsburg Place
Williamsburg
Community Assistant Professor
Department of Family Medicine
Eastern Virginia Medical School
Norfolk
Assistant Clinical Professor
Department of Psychiatry
Virginia Commonwealth University
Richmond
VA
Affiliate Assistant Professor
Department of Psychiatric Medicine
East Carolina University
Greenville
NC
利益声明
JCL declares that he has no competing interests.
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 topic.
利益声明
KB declares that he has received grant support from National Institutes of Health, Lundbeck, Pfizer, and Titan Pharmaceuticals. SM declares that she has received grant support from Pfizer, Titan Pharmaceuticals, Shire, and the Forest Research Institute.
同行评议者
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.
George E. Woody, MD
Emeritus Professor
Department of Psychiatry
Perelman School of Medicine
University of Pennsylvania
Philadelphia
PA
利益声明
GEW declares that he has no competing interests. GEW is an author of a number of references cited in this topic.
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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