首页|半夏厚朴汤加味对海洛因依赖脱毒后稽延性戒断症状和1年复吸率的影响

半夏厚朴汤加味对海洛因依赖脱毒后稽延性戒断症状和1年复吸率的影响

Effect of modified banxia houpu decoction on protracted abstinence syndrome and 1-year relapse rate after heroin-dependence detoxification

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背景:半夏厚朴汤是汉代张仲景治疗情志病名方之一,一直沿用至今用以治疗抑郁症、焦虑症、神经官能症等疾病.目的:观察半夏厚朴汤加味对海洛因依赖脱毒后稽延性戒断症状和1年复吸率的影响,并与服用红糖水模拟制剂作用结果进行比较.设计:随机区组设计,安慰剂随机对照观察.单位:湖北民族学院医学院和恩施自治州公安局戒毒所.对象:选择2000-08/2002-09在湖北恩施自治州公安局强制戒毒所接受强制戒毒的海洛因依赖者187例,男101例,女86例,年龄18~44岁.均对实验目的知情同意.采用随机区组双盲法将纳入对象分为3组:对照组(n=58),服用中药60 d组(n=62)和服用中药72 d组(n=67).方法:①戒毒期间3组均给予盐酸洛啡西定片(由中美合资湖南正太药业有限公司生产,批号:990619,10 mg/片)脱毒治疗12 d后分别隔离给药,即服用半夏厚朴汤加味60 d组不间断服半夏厚朴汤加味煎剂(主要成分:制半夏15 g,姜厚朴30 g,茯苓20 g,紫苏10 g,生姜20g,刺五加20 g,陈皮6 g,大腹皮20 g,藿香10 g,均购自湖北省药材公司),1剂分.2 d 6次服用,共60 d.对照组服30%红糖水模拟制剂共60 d(方法同中药煎剂),服用半夏厚朴汤加味72 d组从用盐酸洛啡西定开始脱毒时即服用等量的半夏厚朴汤加味煎剂共72 d(为比较本药方早期和晚期给药疗效,本组在盐酸洛啡西定脱毒期间12 d内即开始给药,脱毒后继续服用60d).即3组均在从盐酸洛啡西定脱毒治疗开始至停用所有药物共72 d.患者服药采用单盲法.②采用海洛因稽延性戒断症状评定量表(量表内容:失眠状况,疼痛症状群,卡他症状,精神情绪,性功能情况,分别按轻、中、重评1,2,3分.)评估各组稽延性戒断症状轻重.③1年后尿检复查,尿检毒品代谢产物阳性者均视为复吸.④计量和计数资料差异性比较分别用t检验和x2检验.主要观察指标:①各组药物干预后稽延性戒断症状评分结果比较.②各组1年复吸率比较.结果:海洛因依赖者187例均进入结果分析.①服用半夏厚朴汤加味60 d组和服用半夏厚朴汤72 d组的各稽延性戒断症状评分明显低于对照组(P<0.01).服用半夏厚朴汤加味72 d组的疼痛症状和卡他症状评分与服用半夏厚朴汤加味60 d组相当(P>0.05),而失眠症状、精神情绪症状和性功能情况评分却明显低于服用半夏厚朴汤加味60 d组(P<0.01).②服用半夏厚朴汤加味72 d组1年复吸率明显低于对照组和服用半夏厚朴汤加味60d组[73%(49/67),95%(55/58),82%(51/62),P<0.05],而服用半夏厚朴汤加味60 d组1年复吸率与对照组相当(P>0.05).结论:半夏厚朴汤加味可改善海洛因依赖脱毒后的稽延性戒断症状.早期运用半夏厚朴汤加味缓解稽延性戒断症状比后期运用疗效更加明显,有降低复吸率作用.
BACKGROUND: Modified banxia houpu decoction (MBHD) is one of thefamous methods and has been used by Zhang Zhong-jin to treat emotionaldiseases in Han dynasty, and it has been used till now. It can be used totreat depression, anxiety, phychoneurosis and so on.OBJECTIVE: To observe the therapeutic effect of MBHD on treatingheroin abusers with protracted abstinence syndrome and compare the effectwith brown sugar water.DESIGN: Randomized grouping and placebo randomized controlled study.SETTING: School of Medicine, Hubei Institute for Nationalities and theAbstinence Institute of Public Security Bureau of Enshi AutonomousPrepecture.PARTICIPANTS: Totally 187 cases were the abusers of heroin who hadbeen forced to abstinence in the Abstinence Institute of Public SecurityBureau of Enshi Autonomous Prepecture from August 2000 to September2002. There were 101 males and 86 females aged 18-44 years. All pa-tients were known the fact and were randomly divided into control group(n=58), 60-day MBHD group (n=62) and 72-MBHD group (n=67) accordingto double-blind method.METHODS: ① During the abstinence, three groups were treated bylofexidine hydrochloride (LFX) which was produced by the LimitedCompany of Zhengtai Pharmaceuticals Enterprise of Hunan Province (lotnumber: 990619, 10 mg/pill) for 12 days, then they were treated sepa-rated. Give medicine to 60-MBHD group continuously for 60 days (MB-HD: Pinellia Ternate 15 g, Magnolia Bark 30 g, Poria Cocos 20 g, Perilla10 g, Ginger 20 g, Radix Acanthopanacis Senticosi 20 g, Pericarpium CitriReticulate 6 g, Pericarpium Arecae 20 g, Herba Agastachis 10 g. Tradi-tional Chinese medicines were all bought from HuBei Medicine Company;three times a day, one portion for two days), gave the control group red sug-ar water imitate medicine for 60 days (the method was the same as above),72-MBHD group were given the same quantity of MBHD as 60-MBHDgroup when LFX began to detoxifieate, the whole time was 72 days (Thetime before LFX treat 12 days and after 60 days). It took 72 days for thethree groups to be treated by LFX according to single-blind method. ②Heroin protracted abstinence syndrome scale: insomnia, pain syndromes,catarrh syndromes, mental conditions and sexual function. They werescored respectively to 1, 2, 3 according to mild, moderate and severe.③ One year tater collected the urina sanguinis (three times a week con-tinuously) regarded the positive as re-abusers. ④ Measurement andenumeration data were compared with t test and x2 test respectively.MAIN OUTCOME MEASURES: ① Scores of protracted abstinencesyndrome; ② Comparisons of drug re-abusing rate within one year.RESULTS: Totally 187 heroin-dependence patients entered the finalanalysis. ① Scores of protracted abstinence syndrome were lower in 60-day MBHD group and 72-day MBHD group than those in control group(P < 0.01). Scores of pain and catarrh symptoms in 72-day MBHD group were similar to those in 60-day MBHD group (P > 0.05), but scores of insomnia, mental conditions and sexual function were lower than those in 60-day MBHD group (P < 0.01). ② Drug re-abusing rate within one year was lower in 72-day MBHD group than that in control group and 60-day MBHD group [73% (49/67), 95% (55/58), 82% (51/62),P < 0.05],but rate in 60-day MBHD group was similar to that in control group (P > 0.05).CONCLUSION: MBHD can improve the protracted abstinence symptoms of heroin abusers after detoxification. In spite of the complexity of various factors, to effectively control the early stage abstinence symptoms and median stage protracted abstinence symptoms is one of the effective measures to prevent drug re-abusing.

黄德彬、余昭芬、付琳

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湖北民族学院医学院药理教研室,湖北省,恩施市,445000

恩施自治州公安局强制戒毒所,湖北省恩施土家族苗族自治州,445000

物质禁断综合征/中药疗法 半夏厚朴汤 海洛因依赖/治疗 随机分配

湖北省教育厅科研项目国家药品监督管理局资助项目Major Program of Hubei Educational BureauNational Bureau of Drug Supervision and Management

2000 Z 09003TYL200201042000Z09003TYL20020104

2006

中国组织工程研究
中国康复医学会,《中国组织工程研究与临床康复》杂志社

中国组织工程研究

CSTPCDCSCD北大核心
影响因子:1.387
ISSN:2095-4344
年,卷(期):2006.10(11)
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