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Spinal cord ischemia (SCI), a complication of acute aortic dissection, has no established treatment. Here, we report the successful management of three cases of acute type A aortic dissection (ATAAD) with SCI using a multidisciplinary approach. Case 1: A 55-year-old man presented with paraparesis due to ATAAD (non-communicating type), cardiac tamponade, and no loss of consciousness. He underwent emergency surgery for ascending aortic replacement. He awoke 3 h after the surgery; however, as his paralysis was not improved, we initiated multidisciplinary treatment with cerebrospinal drainage, continuous infusion of naloxone, and steroid pulse therapy. These treatments led to the complete resolution of his symptom; he was discharged on Day 32, with no neurological deficits. Case 2: A 50-year-old woman presented with complete paralysis of the left lower limb due to ATAAD (communicating type) but no loss of consciousness. She underwent emergency surgery for ascending aortic replacement. She awoke 2 h after the surgery; however, as her paralysis was not improved, multidisciplinary treatment with cerebrospinal drainage, continuous infusion of naloxone, and steroid pulse therapy were initiated, which led to partial resolution of the symptoms. She could walk with orthotics and was discharged on Day 57. Case 3: A 43-year-old man presented with paraparesis of the left lower limb due to ATAAD (non-communicating type). He was hemodynamically stable, with no loss of consciousness. The ATAAD was conservatively managed, and multidisciplinary treatment with cerebrospinal drainage, continuous infusion of naloxone, and steroid pulse therapy was administered. These therapies led to the complete resolution of his symptoms; he was discharged on Day 46, with no neurological deficits. Hence, for ATAAD with SCI, multidisciplinary treatment, including emergency surgery, is an important therapeutic strategy.
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Objective: To observe the efficacy of acupuncture combined with naloxone hydrochloride in the treatment of coma after surgery for cerebral hemorrhage and to explore its possible mechanism of action. Methods: Seventy-two patients were divided into a control group and an observation group according to the random number table method, with 36 cases in each group. The control group was treated with intravenous naloxone hydrochloride, and the observation group received additional acupuncture treatment. After 1 month of treatment, the awakening rate, Glasgow coma scale (GCS) score, cerebral edema volume, mean velocity (Vm) of the middle cerebral artery, and cerebrospinal fluid Caspase-3, and macrophage migration inhibitory factor (MIF) levels were compared between the two groups. Results: During the study, there were 2 cases of shedding in the control group and 34 remaining valid cases; 1 case of shedding in the observation group and 35 remaining valid cases. After treatment, the awakening rate was higher in the observation group than in the control group (P<0.05); the GCS score increased in both groups compared with that before treatment (P<0.05), and was higher in the observation group than in the control group (P<0.05); the volume of cerebral edema decreased in both groups (P<0.05), and was smaller in the observation group than in the control group (P<0.05); the middle cerebral artery Vm increased in both groups (P<0.05), and was higher in the observation group than in the control group (P<0.05); the cerebrospinal fluid Caspase-3 and MIF levels decreased significantly in both groups (P<0.05) and were lower in the observation group than in the control group (P<0.05). Conclusion: Acupuncture combined with naloxone hydrochloride for the treatment of coma after surgery for cerebral hemorrhage can promote patients' awakening, improve the degree of coma, reduce the volume of cerebral edema, and enhance cerebral blood flow velocity, producing a better effect than naloxone hydrochloride used alone; it may be related to its reduction of cerebrospinal fluid Caspase-3 and MIF levels.
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Although opioids still remain the most powerful pain-killers, the chronic use of opioid analgesics is largely limited by their numerous side-effects, including opioid dependence. However, the mechanism underlying this dependence is largely unknown. In this study, we used the withdrawal symptoms precipitated by naloxone to characterize opioid dependence in mice. We determined the functional role of mu-opioid receptors (MORs) expressed in different subpopulations of neurons in the development of morphine withdrawal. We found that conditional deletion of MORs from glutamatergic neurons expressing vesicular glutamate transporter 2 (Vglut2) largely eliminated the naloxone-precipitated withdrawal symptoms. In contrast, conditional deletion of MORs expressed in GABAergic neurons had a limited effect on morphine withdrawal. Consistently, mice with MORs deleted from Vglut2 glutamatergic neurons also showed no morphine-induced locomotor hyperactivity. Furthermore, morphine withdrawal and morphine-induced hyperactivity were not significantly affected by conditional knockout of MORs from dorsal spinal neurons. Taken together, our data indicate that the development of morphine withdrawal is largely mediated by MORs expressed in Vglut2 glutamatergic neurons.
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Although opioids still remain the most powerful pain-killers, the chronic use of opioid analgesics is largely limited by their numerous side-effects, including opioid dependence. However, the mechanism underlying this dependence is largely unknown. In this study, we used the withdrawal symptoms precipitated by naloxone to characterize opioid dependence in mice. We determined the functional role of mu-opioid receptors (MORs) expressed in different subpopulations of neurons in the development of morphine withdrawal. We found that conditional deletion of MORs from glutamatergic neurons expressing vesicular glutamate transporter 2 (Vglut2) largely eliminated the naloxone-precipitated withdrawal symptoms. In contrast, conditional deletion of MORs expressed in GABAergic neurons had a limited effect on morphine withdrawal. Consistently, mice with MORs deleted from Vglut2 glutamatergic neurons also showed no morphine-induced locomotor hyperactivity. Furthermore, morphine withdrawal and morphine-induced hyperactivity were not significantly affected by conditional knockout of MORs from dorsal spinal neurons. Taken together, our data indicate that the development of morphine withdrawal is largely mediated by MORs expressed in Vglut2 glutamatergic neurons.
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Background: Tramadol use has been increasing in the adult and pediatric population. Practitioners must be alert because Tramadol misuse can lead to severe intoxication in which respiratory failure and seizures are frequent. Overdoses can lead to death. We report 47 pediatric cases with history of accidental tramadol exposure in children.Methods: An observational, retrospective, single center case -series of children with a history of accidental tramadol exposure in children admitted in pediatric intensive care unit of tertiary care center, Niloufer Hospital (Osmania Medical College) Hyderabad, Telangana India.Results: Of 47 children, 22 (47%) are male and 25 (53%) were female. At presentation 11 (23%) had loss of consciousness, 14 (29%) seizures, 17 (36%) hypotonia was noted. Pupils were miotic in 22 (47%) mydriatic in 2 (4.2%) normal in rest of children. Hemodynamic instability noted in 13 (27.6%). Serotonin syndrome (tachycardia, hyperthermia, hypertension, hyper reflex, clonus) was noted on 5 (10.6%) children. Respiratory depression was seen in 4 (8%) children who needed ventilatory support. Antidote Naloxone was given in 7 children. No adverse reaction was noted with Naloxone. All 47 children were successfully discharged.Conclusions: Overdoses can lead to death and practitioners must be alert because of the increasing use of tramadol in the adult and pediatric population. The handling of the tramadol should be explained to parents and general population and naloxone could be efficient when opioid toxicity signs are present.
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Objective@#To investigate the effect of high dose gamma globulin combined with naloxone in the treatment of severe viral encephalitis in children, and its influence on nerve function and immune function.@*Methods@#From March 2012 to May 2017, 103 children with viral encephalitis in the First People's Hospital of Wenling were randomly divided into observation group (53 cases) and control group (50 cases) according to the digital table.The control group was given routine treatment.The observation group was given naloxone combined with high dose gamma globulin on the basis of routine treatment.The therapeutic effect, clinical symptoms, serum neurological function and humoral immune function were compared between the two groups.@*Results@#The total effective rate of the observation group was significantly higher than that of the control group (92.45% vs.78.00%)(χ2=4.319, P<0.05). The clinical symptoms, signs disappearance time and hospitalization time of the observation group were significantly shorter than those of the control group [(2.17±0.56)d vs.(3.12±0.79)d; (2.25±0.31)d vs.(3.87±0.93)d; (3.84±0.46)d vs.(5.31±0.69)d; (2.01±0.83)d vs.(3.86±1.21)d; (1.85±0.58)d vs.(2.79±0.77)d; (11.36±2.14)d vs.(13.05±1.85)d; (10.21±3.05)d vs.(13.85±3.72)d](t=7.072, 11.998, 12.789, 9.093, 7.024, 4.276, 5.444, all P<0.05). After treatment, the serum NSE, S-100β and NGF levels of the two groups were significantly decreased[(12.64±1.22)ng/L vs.(18.95±2.15)ng/L, (0.85±0.24)ng/L vs.(1.69±0.35)ng/L, (0.17±0.05)ng/mL vs.(0.98±0.12)ng/mL, (16.38±1.38)ng/L vs.(19.04±2.78)ng/L, (1.22±0.30)ng/L vs.(1.70±0.41)ng/L, (0.33±0.10)ng/mL vs.(0.96±0.14)ng/mL] (t=18.583, 14.010, 45.361, 6.239, 6.878, 25.58, all P<0.05), and the serum neurological function indicators of the observation group were significantly lower than those of the control group (t=14.592, 6.931, 10.358, all P<0.05). After treatment, the level of IgG in the two groups were significantly higher than those before treatment[(15.62±2.31)g/L vs.(9.12±1.74)g/L; (11.52±2.05)g/L vs.(8.97±1.56)g/L](t=16.363, 6.999, all P<0.05), and the IgG level in the observation group was significantly higher than that in the control group(P<0.05). There were no significant changes in the levels of IgM in the two groups before and after treatment (all P>0.05).@*Conclusion@#High-dose gamma globulin combined with naloxone can effectively improve the clinical efficacy of severe viral encephalitis in children, help to improve the clinical symptoms and signs of children, at the same time help to restore the nervous function of children and improve the humoral immune function, which is worthy of clinical application.
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Objective: To evaluate the effects of different doses of naloxone combined with dezocine on postoperative analgesia in patients with breast cancer. Methods: One hundred and twenty patients with modified radical mastectomy were enrolled in the Tianjin Medical University Cancer Institute and Hospital, between May 2018 and January 2019. The patients were randomly assigned into group L, group M, group H, and group C (n=30). Patients in each group were administered 0.15 mg/kg of dezocine. Patients in group L, group M, and group H were intravenously instilled with naloxone (0.5, 1.0, and 1.5μg/kg, respectively), while patients in group C were administered equal volumes of normal saline. We recorded the time of awakening and removing the laryngeal mask in each group, and the blood pressure and heart rate of each patient around the time of removing the laryngeal mask. We determined the visual analog scale (VAS) scores of pain, Bruggrmann comfort scale (BCS) scores, and Ramsay sedation scores at 1h (T1), 6h(T2), 12h (T3), and 24h (T4) postoperatively, and the number of remedial analgesia and postoperative adverse reactions were recorded in each group after surgery. Results: The time of awakening and removing the laryngeal mask in group L, group M, and group H were shorter than that in group C, and group M had the shortest awakening time (P<0.05). The VAS scores of the patients in group M at T1, T2, and T3 were lower than those in the other three groups (P<0.05). The number of postoperative remedial analgesia and adverse reactions in group C were higher than those in the other three groups (P<0.05). Conclusions:Naloxone (1.0 μg/kg) combined with dezocine (0.15 mg/kg) can enhance the postoperative analgesic effect of dezocine, shorten the awakening time, and reduce the adverse reactions.
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To investigate the effect of high dose gamma globulin combined with naloxone in the treatment of severe viral encephalitis in children ,and its influence on nerve function and immune function.Methods From March 2012 to May 2017,103 children with viral encephalitis in the First People＇s Hospital of Wenling were randomly divided into observation group (53 cases) and control group (50 cases) according to the digital table.The control group was given routine treatment.The observation group was given naloxone combined with high dose gamma globulin on the basis of routine treatment.The therapeutic effect,clinical symptoms,serum neurological function and humoral immune function were compared between the two groups.Results The total effective rate of the observation group was significantly higher than that of the control group (92.45% vs.78.00%) (χ2 ＝4.319,P＜0.05).The clinical symptoms,signs disappearance time and hospitalization time of the observation group were significantly shorter than those of the control group [(2.17 ±0.56) d vs.(3.12 ±0.79) d;(2.25 ±0.31) d vs.( 3.87 ±0.93) d; (3.84 ±0.46)d vs.(5.31 ±0.69)d;(2.01 ±0.83)d vs.(3.86 ±1.21) d;(1.85 ±0.58) d vs.(2.79 ±0.77)d;(11.36 ±2.14)d vs.(13.05 ±1.85) d;(10.21 ±3.05) d vs.(13.85 ±3.72) d] ( t＝7.072,11.998,12.789, 9.093,7.024,4.276,5.444,all P＜0.05).After treatment,the serum NSE,S-100βand NGF levels of the two groups were significantly decreased [(12.64 ±1.22) ng／L vs.(18.95 ±2.15) ng／L, (0.85 ±0.24) ng／L vs. (1.69 ±0.35)ng／L,(0.17 ±0.05)ng／mL vs.(0.98 ±0.12)ng／mL,(16.38 ±1.38)ng／L vs.(19.04 ±2.78)ng／L, (1.22 ±0.30) ng／L vs.(1.70 ±0.41) ng／L,(0.33 ±0.10) ng／mL vs.(0.96 ±0.14) ng／mL] ( t ＝18.583, 14.010,45.361,6.239,6.878,25.58,all P＜0.05),and the serum neurological function indicators of the observation group were significantly lower than those of the control group ( t ＝14.592,6.931,10.358,all P ＜0.05).After treatment,the level of IgG in the two groups were significantly higher than those before treatment [(15.62 ±2.31)g／L vs.(9.12 ±1.74)g／L;(11.52 ±2.05)g／L vs.(8.97 ±1.56)g／L]( t＝16.363,6.999,all P＜0.05),and the IgG level in the observation group was significantly higher than that in the control group (P＜0.05).There were no signifi-cant changes in the levels of IgM in the two groups before and after treatment (all P＞0.05).Conclusion High-dose gamma globulin combined with naloxone can effectively improve the clinical efficacy of severe viral encephalitis
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OBJECTIVES@#To investigate the effectiveness and safety of Xingnaojing Injection (XNJ, ) compared with naloxone for the treatment of acute alcohol intoxication (AAI), and provide the latest evidence through evidence-based approach.@*METHODS@#Seven electro-databases including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure Databases, Chinese Biomedical Literature Database, Chinese Science and Technology Periodical Database (VIP) and Wanfang Database were searched from the inception to January 2018. Randomized controlled trials (RCTs) comparing XNJ with naloxone for patients with AAI and reporting at least one of the below outcomes were included: patients' conscious recovery time, stay length in emergency department, disappearance time of the ataxia symptom, the severity of the symptoms, the blood alcohol content as well as the adverse events. Methodological quality of included trials was assessed using the risk of bias tool which recommended by the Cochrane Collaboration. Meta-analysis was conducted by Review Manager 5.3 software.@*RESULTS@#Totally 141 trials with 13,901 patients were included in this review, all of them were assessed as unclear or high risk of bias. Results showed that on the basis of routine therapy, standard dose XNJ (10-20 mL) may have similar results with naloxone on the recovery time of consciousness (MD 12 min, 95% CI 7.2-17.4 min) and disappearance time of symptoms (MD 6 min, 95% CI-13.8-25.8 min) for patients with AAI. Larger dose of XNJ Injection (21-40 mL) may speed up the time (almost 1 h earlier). Combination of XNJ and naloxone seemed superior to the naloxone alone for all the relevant outcomes. The average difference of time in consciousness recovery was 2 h and the number of AAI patients whose consciousness recovery within 1 h was above 50% the combination group than in the control group (RR 1.42, 95% CI 1.29 to 1.56). No severe adverse events or adverse reactions of XNJ were reported in the included trials.@*CONCLUSIONS@#Low quality of evidence showed XNJ may have equal effect as naloxone and may achieve better effect as add-on intervention with naloxone for patients with AAI. We failed to evaluate the safety of XNJ Injection due to the insufficient evidence in this review. Registration number. in PROSPERO (No. CRD42018087804).
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A 76-year-old man who suffered from consistent back pain was admitted for anti-hypertensive therapy to strictly manage the early thrombosed acute type A aortic dissection (AAAD). On admission, his blood pressure could not be controlled well ; soon he complained of recurrent severe back pain. The second thoracoabdominal enhanced computed tomography revealed the progression of AAAD from DeBakey type II to type I with thrombosed pseudolumen at the descending thoracic aorta ; therefore, emergent surgical intervention by primary central repair was conducted. Paraplegia was diagnosed eight hours after surgery, then cerebrospinal fluid drainage and intravenous administration of Naloxone were started immediately followed by keeping the systemic blood pressure more than 120 mmHg. However, paraplegia had never improved and been persistent with neurological deficit of the lower extremities. We herein report a complicated surgical case of an AAAD patient with paraplegia and review the complex clinical settings.
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BACKGROUND: Severe pain always develops after thoracotomy; intrapleural regional analgesia is used as a simple, safe technique to control it. This study was performed to evaluate whether a small dose of naloxone with local anesthetics prolongs sensory blockade. METHODS: A prospective, randomized double-blinded controlled study was conducted on 60 patients of American Society of Anesthesiologists statuses I and II, aged 18 to 60 years, scheduled for unilateral thoracotomy surgery. After surgery, patients were randomly divided into two groups: through the intrapleural catheter, group B received 30 ml of 0.5% bupivacaine, while group N received 30 ml of 0.5% bupivacaine with 100 ng of naloxone. Postoperative pain was assessed using the visual analog pain scale (VAS). Time for the first request for rescue analgesia, total amount consumed, and incidence of postoperative complications were also recorded. RESULTS: The VAS score significantly decreased in group N, at 6 h and 8 h after operation (P < 0.001 for both). At 12 h after injection, the VAS score increased significantly in group N (P < 0.001). The time for the first request of rescue analgesia was significantly longer in group N compared to group B (P < 0.001). The total amount of morphine consumed was significantly lower in group N than in the bupivacaine group (P < 0.001). CONCLUSIONS: Addition of a small dose of naloxone to bupivacaine in intrapleural regional analgesia significantly prolonged pain relief after thoracotomy and delayed the first request for rescue analgesia, without significant adverse effects.
Subject(s)
Humans , Analgesia , Anesthetics, Local , Bupivacaine , Catheters , Incidence , Interpleural Analgesia , Morphine , Naloxone , Pain Measurement , Pain, Postoperative , Postoperative Complications , Prospective Studies , ThoracotomyABSTRACT
BACKGROUND/AIMS: Opioid-induced constipation (OIC) is the most common gastrointestinal (GI) side effect to opioid treatment. Opioid receptor antagonists against OIC have been introduced, but their efficacy has not been directly compared to conventional laxatives. Our aim was to compare symptoms and objective parameters of gut function in an experimental model of OIC during treatment with the opioid antagonist naloxone and oxycodone in prolonged-release (PR) formulation versus oxycodone plus macrogol 3350. METHODS: In this randomized, double-blind, crossover trial 20 healthy men received a 5-day treatment of combined PR oxycodone/naloxone or PR oxycodone plus macrogol 3350. Regional GI transit times and segmental colorectal transit were assessed with the Motilis 3D-Transit electromagnetic capsule system. Colorectal volumes were determined by MRI. OIC symptoms were assessed with validated questionnaires, along with stool frequency and consistency. RESULTS: Total colorectal volume did not change after 5 days’ treatment with PR oxycodone/naloxone (941 vs 1036 mL; P = 0.091), but increased significantly after PR oxycodone plus macrogol treatment (912 vs 1123 mL; P 0.05). The Patient Assessment of Constipation Symptom Questionnaire abdominal symptoms score was lower during PR oxycodone/naloxone compared to PR oxycodone plus macrogol (0.2 vs 3.2; P = 0.002). Stool frequency was lower during PR oxycodone/naloxone compared to PR oxycodone plus macrogol (4.2 vs 5.4; P = 0.035). CONCLUSIONS: PR oxycodone plus macrogol increases colorectal volume, but does not improve GI transit compared to PR oxycodone/naloxone. However, PR oxycodone/naloxone results in a lower abdominal symptom burden, despite higher stool frequency during macrogol treatment.
Subject(s)
Humans , Male , Analgesics, Opioid , Constipation , Laxatives , Magnetic Resonance Imaging , Magnets , Models, Theoretical , Naloxone , Narcotic Antagonists , Oxycodone , Polyethylene GlycolsABSTRACT
Objective To compare the effects of caffeine citrate and aminophylline combined with naloxone in the treatment of premature infants with apnea.Methods From March 2015 to March 2017,140 premature infants with apnea who were treated in neonatal intensive care unit in Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou were selected in the research.The children were randomly divided into the study group and the control group according to the digital table,with 70 cases in each group.The control group was treated with aminophyl-line combined with naloxone,and the observation group was treated with caffeine citrate.The adverse reaction of children during the treatment was recorded,and the level of apnea was evaluated after treatment.The blood gas index of children before and after 48h treatment was compared,the mortality rate of the children was counted,and the incidence of brain injury during the 1 year follow -up was analyzed.Results After treatment for 48h,the level of PaO2in the two groups was significantly higher [study group: (10.54 ±0.41) kPa,control group: (9.66 ± 0.39) kPa] than those before treatment[study group: (7.18 ±0.26) kPa,control group: (7.21 ±0.24) kPa],and the level of PaCO2[study group: (5.31 ±0.24) kPa,control group: (5.82 ±0.25) kPa]was significantly lower than those before treatment[study group: (6.83 ±0.28) kPa,control group: (6.77 ±0.30) kPa](t＝19.153,13.624,11.271,7.304;P＝0.000,0.000,0.000,0.000),and the level of PaO2in the study group was significantly higher than that in the control group,and the level of PaCO 2in the study group was significantly lower than that in the control group(t＝6.029,4.327;P＝0.000,0.000).The overall effective rate of apnea therapy in the study group (92.86%) was significantly higher than 77.14%in the control group (χ2＝4.509,P＝0.034).The mortality rate(1.43%) and the incidence rate of brain injury (0.00%) of the study group were significantly lower than those of the control group (10.00%and 7.14%)(χ2＝4.773,5.185;P＝0.029,0.023).The incidence rate of adverse reactions (30.00%) of the study group was significantly lower than 50.00%of the control group (χ2＝5.833,P＝0.016).The endometri-al thickness of the study group was significantly lower than that of the control group (P＜0.05).The rate of ovulation success(87.84%) and pregnancy success rate (45.94%) of the study group were significantly higher than those of the control group(72.97%and 28.39%)(χ2＝5.189,4.890;P＝0.023,0.027).The rate of abortion(8.82%) of the study group was significantly lower than 33.33%of the control group (χ2＝5.242,P＝0.022).During the period of treatment,the incidence rate of adverse drug reactions (6.77%) of the study group was not significantly different from 8.11%of the control group (χ2＝0.098,P＝0.754).Conclusion Compared with aminophylline combined with naloxone treatment,caffeine citrate can significantly improve the blood gas status of apnea preterm infants,improve the overall curative effect of apnea,prevent the occurrence of neonatal death and brain injury,and reduce the adverse reactions of the children during the treatment.It is worthy of clinical application.
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BACKGROUND: A prolonged-release formulation of oxycodone/naloxone has been shown to be effective in European populations for the management of chronic moderate to severe pain. However, no clinical data exist for its use in Korean patients. The objective of this study was to assess efficacy and safety of prolonged-release oxycodone/naloxone in Korean patients for management of chronic moderate-to-severe pain. METHODS: In this multicenter, single-arm, open-label, phase IV study, Korean adults with moderate-to-severe spinal disorder-related pain that was not satisfactorily controlled with weak opioids and nonsteroidal anti-inflammatory drugs received prolonged-release oral oxycodone/naloxone at a starting dose of 10/5 mg/day (maximum 80/40 mg/day) for 8 weeks. Changes in pain intensity and quality of life (QoL) were measured using a numeric rating scale (NRS, 0–10) and the Korean-language EuroQol-five dimensions questionnaire, respectively. RESULTS: Among 209 patients assessed for efficacy, the mean NRS pain score was reduced by 25.9% between baseline and week 8 of treatment (p < 0.0001). There was also a significant improvement in QoL from baseline to week 8 (p < 0.0001). The incidence of adverse drug reactions was 27.7%, the most common being nausea, constipation, and dizziness; 77.9% of these adverse drug reactions had resolved or were resolving at the end of the study. CONCLUSIONS: Prolonged-release oxycodone/naloxone provided significant and clinically relevant reductions in pain intensity and improved QoL in Korean patients with chronic spinal disorders. (ClinicalTrials.gov identifier: NCT01811238)
Subject(s)
Adult , Humans , Analgesia , Analgesics, Opioid , Chronic Pain , Constipation , Dizziness , Drug-Related Side Effects and Adverse Reactions , Incidence , Nausea , Quality of Life , SpineABSTRACT
Objective To analyze the clinical effect of naloxone in the treatment of patients with acute cerebral infarction ( ACI) .Methods 86 patients with ACI were selected as study objects ,and they were divided into control group and observation group ,with 43 cases in each group .The control group was given conventional treatment , the observation group received conventional treatment combined with naloxone .The treatment effect was compared between the two groups .Results The total effective rate of the observation group was 86.05%,which was higher than 67.44%of the control group(χ2=4.169,P<0.05).After treatment,the NDS score,plasma nitric oxide(NO) and endothelin(ET) in the observation group were (11.55 ±3.89)points,(54.68 ±8.12)μmol/L,(53.98 ±8.44)ng/L, respectively,which in the control group were (17.68 ±3.84)points,(40.75 ±8.23)μmol/L,(68.02 ±8.47)ng/L, respectively,the differences were statistically significant (t =7.354,7.900,7.699,all P <0.05).Conclusion Application of naloxone on the basis of routine treatment in the treatment of ACI can obviously improve the symptoms of hypoxia and therapeutic effect .
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A nivel mundial la dependencia a opiáceos es un problema vigente, y los pacientes afectados por esta condición requieren programas de tratamiento sustitutivo farmacológico, que utilizan tradicionalmente Metadona. Actualmente, existe debate sobre el hecho de que la Buprenorfina/Naloxona podria ser utilizada como un reemplazo adecuado del fármaco tradicional. Las investigaciones aún no son totalmente concluyentes, faltando estudios que prueben los resultados en la práctica clínica. Objetivos: Determinar la efectividad del tratamiento con Buprenorfina/Naloxona como reemplazo de la metadona en pacientes dependientes de opiáceos tratados en un Módulo de Asistencia Psicosocial en la ciudad de Bilbao, España. Métodos: Se realizó un estudio cuasiexperimental, cuantitativo, longitudinal, prospectivo, con 21 pacientes dependientes de opiáceos que formaban parte del Programa de mantenimiento con Metadona con dosis inferiores o iguales a 40 mg/día, en quienes se sustituyó ese tratamiento por el de Buprenorfina/Naloxona (8mg/2mg) siguiendo para esto los criterios de la Guía para el tratamiento de la adicción a opiáceos con Buprenorfina/Naloxona de la Sociedad Científica Española de estudios sobre alcohol, el alcoholismo y otras toxicomanías del 2010. Resultados: Después de tres meses de cambio de terapéutica a Buprenorfina/Naloxona se evidencio una reducción estadísticamente significativa en el consumo de opiáceos ilegales, medido a través de los controles de substancias en orina desde un promedio de 2,67 controles positivos con metadona, a 2,24 controles con Buprenorfina/Naloxona. La adherencia, se mantuvo similar a la previa, presentando además una retención del 100% de los pacientes. La calidad de vida, medida con el Test TECVASP, presento una mejora estadísticamente significativa, desde una puntuación de 76,76 cuando recibían Metadona (DE 6,41) hasta 90,33 (DE 5,77 ) con la nueva terapéutica. Conclusiones: Cambiar la terapia de mantenimiento con Metadona, en pacientes dependientes de opioides, por buprenorfina/naloxona es una buena opción, ya que tiene una efectividad similar en términos de adherencia y retención, y produce una mayor reducción en el uso de opiáceos ilegales, al tiempo que mejora la calidad de vida del paciente.
At the global level, opioid dependence is an ongoing problem, and patients with this condition require pharmacological substitution treatment programs, which traditionally use methadone. Currently there is debate over whether Buprenorphine / Naloxone could be used as a suitable replacement for the traditional drug. The investigations are not yet totally conclusive, lacking studies that prove the results in the clinical practice. Objectives: To determine the effectiveness of treatment with Buprenorphine / Naloxone as a replacement for Methadone in opioid dependent patients treated in a Psychosocial Assistance Module in the city of Bilbao, Spain. Methods: A quasi-experimental, quantitative, longitudinal, prospective study was conducted with 21 opioid-dependent patients that were part of the maintenance program with Methadone at doses lower than or equal to 40 mg / day, in which treatment was replaced by that of Buprenorphine / Naloxone (8 mg/2 mg) following for this the criteria of the Guide for the treatment of the addiction to opiates with Buprenorphine / Naloxone of the Spanish Scientific Society of studies on alcohol, alcoholism and other drug addictions of 2010. Results: After a three-month change in therapy to Buprenorphine / Naloxone, a statistically significant reduction in illegal opioid use was observed, measured through urine substance controls from an average of 2.67 methadone-positive controls 2.24 controls with Buprenorphine / Naloxone. The Adherence remained similar to the previous one, presenting a retention of 100% of the patients. Quality of life, measured with the TECVASP test, showed a statistically significant improvement, from a score of 76.76 when receiving Methadone (DE 6.41) to 90.33 (DE 5.77) with the new therapy. Conclusions: Changing maintenance therapy with methadone, in opioid-dependent patients, by buprenorphine/naloxone is a good option, because it has a similar effectiveness in terms of adherence and retention, and produces a greater reduction in the use of illegal opiates, and the same time improves the quality of life of the patient.
Subject(s)
Humans , Substance-Related Disorders , Buprenorphine/administration & dosage , Opiate Substitution TreatmentABSTRACT
Objective To explore the clinical effect of Xingnaojing combined with naloxone in patients with severe alcoholism in emergency department. Methods 334 cases with severe alcoholism were enrolled in the first affiliated hospital of Xinjiang medical university from January 2016 to January 2017. All patients were randomly divided into three groups. The first group was treated with Xingnaojing alone. The second group was treated with naloxone alone. The third group was treated with Xingnaojing combined with naloxone. Results The patients in the third group had good effect in terms of recovery time, respiratory recovery and initial temperature recovery of body temperature, and could also be effective in the treatment of the three groups of patients. Conclusion Xingnaojing combined with naloxone in the patients with severe alcoholism with emergency rescue has a good effect, which can be vigorously promoted in clinical practice.
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Objective To observe the effect of Nalmefene on postoperative recovery on neonates by laparoscopic pyloromyotomy. Methods Elective laparoscopic pyloromyotomy for 60 neonates under general anestheisa, aged 15 ~ 28 days, ASA Ⅱ~Ⅲ , were randomly divided into two groups: Nalmefene group (M group) and Naloxone group (L group), 30 cases in each. Nalmefene 0.25 μg/kg and Naloxone 1.00 μg/kg were respectively administrated in M group and L group when the procedures finished. Parameters SpO2, MAP, HR and RR were measured and analyzed statistically at different times: end of surgery before drugs were used (T0), 10 min after administration (T1), 30 mins after extubation (T2) and 2 h after extubation (T3). Meanwhile observing spontaneous breathing recovery time, extubation time, residence time at PACU and adverse events 24 s after surgery. Results There were no actual differences in the value of MAP, HR and SpO2 at T0, T1, T2 and T3 times in the two groups (P > 0.05). However, the values of RR was significant faster at T1, T2 and T3 times than that at T0 in both groups (P < 0.05), compared with L group, the value of RR at T1 was much faster in M group (P < 0.05). The times of extubation and residence at PACU have significant differences in M group than that in L group (P < 0.05). The adverse events in both groups have no differences. Conclusion Nalmefene can facilitate the recovery at laparoscopic pyloromyotomy on neonates. Compared with naloxone, it can reduce the extubation time, and promote the early rehabilitation.
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Objective To investigate the clinical effect of treatment of severe carbon monoxide poisoning with Naoxingjing injection combined with naloxone.Methods Emergency department of affiliated theorem clinical college, hospital 70 patients diagnosed with severe carbon monoxide poisoning from emergency department in June 2014 to December 2016, were randomly divided into observation group and control group 35 cases.In the control group were treated with naloxone treatment, observation group were treated based on the use Naoxingjing injection treatment.The two groups were observed and recorded recovery time, mortality, the incidence of delayed encephalopathy, Glasgow Coma Score(GCS)and serum levels of IL-1β.Results The patients in the observation group total effective rate of 97.14% was significantly higher than 77.14%, and the difference was statistically significant(P<0.05);the recovery time was observed in patients(2.25 ± 0.88)h, significantly shorter than the control group(3.46 ± 1.10)h, and the difference was statistically significant(P<0.05);and follow-up observation group mortality rates were delayed encephalopathy(1.43%, 8.57%)than the control group(17.14%, 25.71%), and the difference was statistically significant(P<0.05);④ observation group were GCS score was (12.77±1.89), significantly better than the control group, and the difference was statistically significant(P<0.05);⑤ observed in patients IL-1β is(65.41±9.93)ng / L was significantly lower than the control group(89.86±10.74)ng / L, and the difference was statistically significant(P<0.05).Conclusion Naoxingjing injection combined with naloxone treatment of severe carbon monoxide poisoning exact clinical effect, can effectively reduce patient recovery time, reduce mortality and morbidity.
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Objective To evaluate the effect of ropivacaine combined with low-dose naloxone or sufentanilropivacaine mixture on brachial plexus block carried under the guidance of ultrasound.Methods A total of 100 patients of our hospital undergoing upper limb surgery was randomly divided into four groups with 25 patients in each group.Four groups are patients receiving 20 mL of 0.375％ mesylate ropivacaine (Group D),20 mL of 0.375％ mesylate ropivacaine + 10 μg sufentanil (Group S),20 mL of 0.375％ mesylate ropivacaine + 100 ng naloxone (Group N) and 20 mL of 0.375％ mesylate ropivacaine + 10 μg sufentanil +100 ng naloxone (Group N+S).All patients underwent interscalene brachial plexus block under ultrasound guidance.The sensory block,motor block and other adverse reactions were observed and recorded at 5min,6,12,18,24 h.Results The sensory and motor block time of group D was (435.5 ± 77.9) min and (350.2 ± 69.8) min,group S (831.7 ± 52.0)min and (675.8 ± 48.1)min,group N (933.0 ± 117.1) min and (499.0 ± 40.5) min,group N+S (919.3 ± 59.0) min and (534.8 ± 56.6)min.The sensory block time of group N and group N + S were significantly longer than that of group D and S (P ＜0.05).The sensory and motor block time of group D were obviously shorter than that of other groups (P ＜ 0.05).There were no significant difference in the onset time of sensory and motor block in all groups.Conclusion Low dose of naloxone combined with ropivacaine or sufentanil-ropivacaine mixture can increase the duration of sensory block on brachial plexus.