Clinical Toxicology Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Emerg Med Australas. 2020 Feb;32(1):88-92. doi: 10.1111/1742-6723.13344. Epub 2019 Jul 21.
Naloxone is an established antidote for the treatment of heroin poisoning; however, dosing regimens vary widely, with a current trend towards small titrated intravenous dosing. This study aims to characterise naloxone use in the treatment of patients presenting with suspected heroin poisoning.
This was a retrospective review of poisoned patients presenting to a clinical toxicology unit in Brisbane from January 2015 to December 2017. Patient demographics, clinical effects, naloxone dosing, observation periods and complications were extracted from the patient's medical records.
There were 117 presentations accounted for by 108 patients. Prehospital naloxone was provided to 57 (49%) patients, 46 of which received a standardised 1.6 mg i.m. dose. The remaining 60 (51%) patients received their first naloxone in hospital, with 58 (97%) receiving this by titrated i.v. doses. A subsequent naloxone infusion was required significantly more often in those treated with i.v. titrated naloxone compared to i.m. dose (27/69 [39%] vs 5/48 [10%], P = 0.0006). The need for parenteral sedation to manage acute behavioural disturbance following naloxone provision was rare (3/117 [3%]).
In this retrospective observational study, a single large i.m. dose of naloxone reversed the toxicity of suspected heroin overdose in the majority of patients. In addition, patients were less likely to require repeated intermittent doses or naloxone infusion than those treated solely with i.v. naloxone. Further comparison in a prospective study is warranted to validate these observations in confirmed heroin overdose. Requirement for sedation secondary to acute behavioural disturbance was rare regardless of the route.
纳洛酮是治疗海洛因中毒的一种已确立的解毒剂；然而，剂量方案差异很大，目前的趋势是小剂量静脉滴定给药。本研究旨在描述纳洛酮在治疗疑似海洛因中毒患者中的使用情况。
这是对 2015 年 1 月至 2017 年 12 月布里斯班临床毒理学单位收治的中毒患者进行的回顾性研究。从患者病历中提取患者人口统计学资料、临床效应、纳洛酮剂量、观察期和并发症。
共有 108 名患者的 117 次就诊。57 名（49%）患者接受了院前纳洛酮治疗，其中 46 名患者接受了标准的 1.6mg 肌内注射剂量。其余 60 名（51%）患者在医院接受了第一次纳洛酮治疗，其中 58 名（97%）患者通过滴定静脉剂量接受治疗。与肌内注射剂量相比，接受静脉滴定纳洛酮治疗的患者更需要随后的纳洛酮输注（27/69 [39%] 比 5/48 [10%]，P = 0.0006）。纳洛酮给药后，需要静脉给予镇静剂来控制急性行为紊乱的情况很少见（3/117 [3%]）。
在这项回顾性观察性研究中，大剂量肌内注射纳洛酮逆转了大多数疑似海洛因中毒患者的毒性。此外，与仅接受静脉纳洛酮治疗的患者相比，需要重复间歇性剂量或纳洛酮输注的患者更少。需要在一项前瞻性研究中进一步比较，以验证这些在确诊的海洛因中毒中的观察结果。无论给药途径如何，因急性行为紊乱而需要镇静的情况都很少见。
