Goldberg I, Bahar A, Yosipovitch Z
Clin Orthop Relat Res. 1984 Sep(188):223-9.
A case of inadvertent intra-arterial self-injection of crushed codeine tablets in an 37-year-old man, resulting in gangrene of an upper extremity, is presented. The problem studied was whether the gangrene was caused by the codeine or by one of the excipients found in the tablets. The cause of the gangrene was investigated in an experimental study. Each of the components of the tablet (codeine, lactose, gelatin, carboxymethyl cellulose, calcium stearate, talc, and microcrystalline cellulose) was injected into the femoral arteries of dogs. The results of the study clearly demonstrate that the unique component producing the gangrene was the micro-crystalline cellulose, while the injection of pure codeine was harmless. To date, the only reported deleterious effects of intravascular injection of micro-crystalline cellulose have been pulmonary embolism and granulomatosis. Some examples of drugs that include microcrystalline cellulose are methadone, methaqualone, oxcycodone, acetaminophen, aspirin with codeine, propoxyphene napsylate, meprobamate, and phenobarbital. Recently, the vulnerability of drug addicts who habitually inject drugs into veins to the accidental injection of an artery has been noted, and it seems likely that in the future the problem of intra-arterial injection will increase in severity. The literature of the last 40 years is reviewed, and a list of drugs known to have produced gangrene when injected intra-arterially is cited.
本文报告了一例37岁男性意外动脉内自我注射碾碎的可待因片剂，导致上肢坏疽的病例。所研究的问题是坏疽是由可待因还是片剂中的一种辅料引起的。在一项实验研究中对坏疽的原因进行了调查。将片剂的每种成分（可待因、乳糖、明胶、羧甲基纤维素、硬脂酸钙、滑石粉和微晶纤维素）注入狗的股动脉。研究结果清楚地表明，导致坏疽的唯一成分是微晶纤维素，而注射纯可待因是无害的。迄今为止，血管内注射微晶纤维素唯一报告的有害影响是肺栓塞和肉芽肿形成。含有微晶纤维素的药物实例包括美沙酮、甲喹酮、羟考酮、对乙酰氨基酚、含可待因的阿司匹林、萘磺酸丙氧芬、甲丙氨酯和苯巴比妥。最近，人们注意到习惯性静脉注射毒品的吸毒者易发生意外动脉注射，未来动脉内注射问题的严重性似乎可能会增加。回顾了过去40年的文献，并列举了已知动脉内注射会导致坏疽的药物清单。
