Glaizal Mathieu, Lucciardi Joseph, Tichadou Lucia, Spadari Michel, Hayek-Lanthois Maryvonne, Micallef Joëlle, de Haro Luc
Centre AntiPoison et de Toxicovigilance, Hôpital Salvator, AP-HM, Marseille, France.
Therapie. 2011 Nov-Dec;66(6):545-7. doi: 10.2515/therapie/2011069. Epub 2011 Dec 21.
High dosage buprenorphine (HDB) is a sublingual maintenance treatment of opioid dependence which have proved its substantial Public Health results, but it is also known to be frequently abused and diverted, in particular for intravenous injection, with deleterious consequences. Intra-arterial use is more rarely reported with this substance, just like its complications, mainly ischemic, potentially necrotic, phenomena. We report here such a case, with a 30 years-old man suffering from severe ischemia of the thumb, the forefinger and the middle finger few hours after direct injection of a suspension of buprenorphine crushed tablets in right radial arteria. A treatment combining surgery (video-thoracoscopic thoracic sympathectomy) and medicines (heparin, iloprost and piribedil mesilate), permitted a semi-complete digital rehabilitation (only forefinger pulp necrosis persisted and required a distal amputation), and the patient was discharged after 2 weeks.
高剂量丁丙诺啡（HDB）是一种用于阿片类药物依赖的舌下维持治疗方法，已证明其具有显著的公共卫生效果，但也已知其经常被滥用和转移，特别是用于静脉注射，会产生有害后果。动脉内使用这种物质的情况较少被报道，其并发症也是如此，主要是缺血性、潜在坏死性现象。我们在此报告这样一个病例，一名30岁男性在将丁丙诺啡碾碎片混悬液直接注射到右侧桡动脉几小时后，出现拇指、示指和中指严重缺血。一种结合手术（电视胸腔镜胸交感神经切除术）和药物（肝素、伊洛前列素和甲磺酸培高利特）的治疗方法，使手指得到了半完全康复（仅示指指腹坏死持续存在并需要进行远端截肢），患者在2周后出院。
