Jones Hendree E, Martin Peter R, Heil Sarah H, Kaltenbach Karol, Selby Peter, Coyle Mara G, Stine Susan M, O'Grady Kevin E, Arria Amelia M, Fischer Gabriele
Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
J Subst Abuse Treat. 2008 Oct;35(3):245-59. doi: 10.1016/j.jsat.2007.10.007. Epub 2008 Jan 14.
This article addresses common questions that clinicians face when treating pregnant women with opioid dependence. Guidance, based on both research evidence and the collective clinical experience of the authors, which include investigators in the Maternal Opioid Treatment: Human Experimental Research (MOTHER) project, is provided to aid clinical decision making. The MOTHER project is a double-blind, double-dummy, flexible-dosing, parallel-group clinical trial examining the comparative safety and efficacy of methadone and buprenorphine for the treatment of opioid dependence in pregnant women and their neonates. The article begins with a discussion of appropriate assessment during pregnancy and then addresses clinical management stages including maintenance medication selection, induction, and stabilization; opioid agonist medication management before, during, and after delivery; pain management; breast-feeding; and transfer to aftercare. Lastly, other important clinical issues including managing co-occurring psychiatric disorders and medication interactions are discussed.
本文探讨了临床医生在治疗阿片类药物依赖孕妇时面临的常见问题。基于研究证据以及包括“孕期阿片类药物治疗：人体实验研究”（MOTHER）项目的研究人员在内的作者们的集体临床经验，提供了相关指导，以协助临床决策。MOTHER项目是一项双盲、双模拟、灵活给药、平行组临床试验，旨在研究美沙酮和丁丙诺啡治疗孕妇及其新生儿阿片类药物依赖的相对安全性和有效性。文章首先讨论了孕期的适当评估，然后阐述了临床管理阶段，包括维持药物选择、诱导和稳定；分娩前、期间和之后的阿片类激动剂药物管理；疼痛管理；母乳喂养；以及过渡到后续护理。最后，讨论了其他重要的临床问题，包括并发精神障碍的管理和药物相互作用。
