Boyd J J, Kuisma M J, Alaspää A O, Vuori E, Repo J V, Randell T T
Helsinki Emergency Medical Service, Helsinki University Central Hospital, Helsinki, Finland.
Acta Anaesthesiol Scand. 2006 Nov;50(10):1266-70. doi: 10.1111/j.1399-6576.2006.01172.x.
In patients with presumed heroin overdose, the recommended time of observation after reversing heroin toxicity with naloxone varies widely. The aims of this study were to examine the incidence of recurrent opioid toxicity and the time interval in which it occurs after pre-hospital treatment in presumed heroin overdose patients.
We undertook a retrospective study in Helsinki (population, 560,000). Records were reviewed from 1 January 1995 to 31 December 2000. Patients included were treated by the emergency medical service (EMS) for a presumed heroin overdose. Patients with known polydrug/alcohol use or the use of opioids other than heroin were excluded. The EMS records were compared with the cardiac arrest database and the medical examiners' records.
One hundred and forty-five patients were included. The median dose of pre-hospital administered naloxone was 0.4 mg. After pre-hospital care, 84 patients refused further care and were not transported to an emergency department (ED). Seventy-one received pre-hospital naloxone, and no life-threatening events were recorded during a 12-h follow-up period in these patients. After pre-hospital care, 61 patients were transported to an ED. Twelve patients received naloxone in the ED for respiratory depression. All had signs of heroin use-related adverse events within 1 h after receiving pre-hospital naloxone.
Allowing presumed heroin overdose patients to sign out after pre-hospital care with naloxone is safe. If transported to an ED, a 1-h observation period after naloxone administration seems to be adequate for recurrent heroin toxicity.
在疑似海洛因过量的患者中，使用纳洛酮逆转海洛因毒性后推荐的观察时间差异很大。本研究的目的是检查复发性阿片类药物毒性的发生率以及在疑似海洛因过量患者的院前治疗后发生复发性阿片类药物毒性的时间间隔。
我们在赫尔辛基（人口56万）进行了一项回顾性研究。回顾了1995年1月1日至2000年12月31日的记录。纳入的患者由紧急医疗服务（EMS）治疗，疑似海洛因过量。排除已知使用多种药物/酒精或使用除海洛因以外的阿片类药物的患者。将EMS记录与心脏骤停数据库和法医记录进行比较。
纳入145例患者。院前给予纳洛酮的中位剂量为0.4mg。院前护理后，84例患者拒绝进一步护理，未被送往急诊科（ED）。71例接受了院前纳洛酮治疗，在这些患者的12小时随访期内未记录到危及生命的事件。院前护理后，61例患者被送往ED。12例患者在ED因呼吸抑制接受纳洛酮治疗。所有患者在接受院前纳洛酮后1小时内均有海洛因使用相关不良事件的体征。
允许疑似海洛因过量患者在院前使用纳洛酮护理后签字离开是安全的。如果被送往ED，纳洛酮给药后1小时的观察期似乎足以检测复发性海洛因毒性。
