Department of Internal Medicine, Forest Hills Hospital, New York, NY.
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Hofstra Northwell School of Medicine, North Shore University Hospital & Long Island Jewish Medical Center, New Hyde Park, NY.
Am J Ther. 2019 May/Jun;26(3):e380-e387. doi: 10.1097/MJT.0000000000000681.
Opioids are natural, semisynthetic, or synthetic substances that act on opioid receptors in the central nervous system. Clinically, they are prescribed for pain management. Opioid overdose (OOD) occurs when the central nervous system and respiratory drive are suppressed because of excessive consumption of the drug. Symptoms of OOD include drowsiness, slow breathing, pinpoint pupils, cyanosis, loss of consciousness, and death. Due to their addictive potential and easy accessibility opioid addiction is a growing problem worldwide. Emergency medical services and the emergency department often perform initial management of OOD. Thereafter, some patients require intensive care management because of respiratory failure, metabolic encephalopathy, acute kidney injury, and other organ failure.
We sought to review the literature and present the most up-to-date treatment strategies of patients with acute OOD requiring critical care management.
A PubMed search was conducted to review all articles between 1950 and 2017 and the relevant articles were cited.
RESULTS & CONCLUSIONS: Worldwide, approximately 69,000 people die of OOD each year, and approximately 15 million people have opioid addiction. In the United States, death from OOD has increased almost 5-fold from 2001 to 2013. OOD leading to intensive care unit admission has increased by 50% from 2009 to 2015. At the same time, the mortality associated with these admissions has doubled. The management strategies include airway management, use of reversal agents, assessing and treating coingestions and associated complications, treatment of opioid withdrawal with alpha-agonists, and psychosocial support to help with opiate addiction and withdrawal. This warrants awareness among clinicians regarding the adverse effects associated with opioid use, management strategies, and calls for a multidisciplinary approach to treating these patients.
阿片类药物是作用于中枢神经系统阿片受体的天然、半合成或合成物质。临床上，它们被用于疼痛管理。阿片类药物过量（OOD）是由于药物过量导致中枢神经系统和呼吸驱动力受到抑制而发生的。OOD 的症状包括嗜睡、呼吸缓慢、针尖样瞳孔、发绀、意识丧失和死亡。由于阿片类药物具有成瘾性和易获得性，阿片类药物成瘾已成为全球日益严重的问题。急救医疗服务和急诊科经常对 OOD 进行初步治疗。此后，一些患者由于呼吸衰竭、代谢性脑病、急性肾损伤和其他器官衰竭需要重症监护管理。
我们试图查阅文献并提出目前需要重症监护管理的急性 OOD 患者的最新治疗策略。
进行了 PubMed 检索，以查阅 1950 年至 2017 年期间的所有文章，并引用了相关文章。
全球每年约有 6.9 万人死于 OOD，约有 1500 万人患有阿片类药物成瘾。在美国，OOD 导致的死亡人数从 2001 年到 2013 年几乎增加了 5 倍。从 2009 年到 2015 年，因 OOD 而住院进入重症监护病房的人数增加了 50%。与此同时，这些住院患者的死亡率增加了一倍。治疗策略包括气道管理、使用逆转剂、评估和治疗合并症及相关并发症、使用α激动剂治疗阿片类药物戒断以及提供社会心理支持以帮助治疗阿片类药物成瘾和戒断。这需要临床医生认识到与阿片类药物使用相关的不良反应、管理策略，并呼吁采取多学科方法治疗这些患者。
