A community-based evaluation of sudden death associated with therapeutic levels of methadone
A community-based evaluation of sudden death associated with therapeutic levels of methadone
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DOI：
10.1016/j.amjmed.2007.10.009
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发表时间：
2008-01-01
影响因子：
5.9
通讯作者：
Gunson, Karen
中科院分区：
文献类型：
--
作者：
Chugh, Sumeet S.;Socoteanu, Carmen;Gunson, Karen
背景：已发表的病例报告将美沙酮的治疗性使用与偶尔发生的心源性猝死联系起来。由于这种药物的既定效用和最终的目标是提高使用的安全性，我们进行了一项以社区为基础的研究，以评估这种association.METHODS：在4年的时间内，我们前瞻性地评估了所有患者谁连续心脏性猝死，并进行了调查的医学检查员在大都会地区的波特兰，俄勒冈州。感兴趣的病例受试者是那些具有美沙酮治疗血液水平（< 1 mg/L）的受试者，而病例比较受试者是那些没有确定美沙酮的受试者。两组均排除了娱乐性药物使用或任何药物过量的患者。详细的尸体解剖，包括检测和定量的所有物质在血液中。结果：共22例心脏性猝死的美沙酮治疗水平（平均0.48 +/- 0.22毫克/升;范围0.1-0.9 mg/L）（平均年龄37.0 ± 10岁，68%为男性），并与106例无美沙酮证据的连续心源性猝死病例（平均年龄42 +/- 13岁，69%为男性）进行比较。美沙酮使用最常见的适应症是疼痛控制（n = 12，55%）。在接受美沙酮治疗的病例中，仅23%（n = 5）的患者发现了猝死相关的心脏异常，其余77%（n = 17）的患者没有明确的心脏猝死原因。在没有美沙酮的情况下，猝死相关的心脏异常被确定为60%（n = 64，P = .002）。结论：心脏病的患病率显着降低的情况下，组牵连美沙酮，即使在治疗水平，作为猝死的可能原因。这些发现指出美沙酮与社区猝死发生之间的联系。临床保障措施和进一步的前瞻性研究，专门设计，以提高美沙酮使用的安全性是必要的。(C)2008年爱思唯尔公司All rights reserved.
BACKGROUND: Published case reports have associated the therapeutic use of methadone with the occasional occurrence of sudden cardiac death. Because of the established utility of this drug and with the eventual goal of enhancing safety of use, we performed a community- based study to evaluate this association.METHODS: During a 4-year period, we prospectively evaluated all patients who consecutively had sudden cardiac death and underwent investigation by the medical examiner in the metropolitan area of Portland, Ore. Case subjects of interest were those with a therapeutic blood level of methadone (< 1 mg/L), and case comparison subjects were those with no methadone identified. Patients with recreational drug use or any drug overdose were excluded from either group. Detailed autopsies were conducted, including the detection and quantification of all substances in the blood.RESULTS: A total of 22 sudden cardiac death cases with therapeutic levels of methadone ( mean 0.48 +/- 0.22 mg/L; range 0.1-0.9 mg/L) were identified (mean age 37.0 +/- 10 years, 68% were male) and compared with 106 consecutive sudden cardiac death cases without evidence of methadone ( mean age 42 +/- 13 years, 69% were male). The most common indication for methadone use was pain control (n = 12, 55%). Among cases receiving methadone therapy, sudden death-associated cardiac abnormalities were identified in only 23% (n = 5), with no clear cause of sudden cardiac death in the remaining 77% (n = 17). Among cases with no methadone, sudden death-associated cardiac abnormalities were identified in 60% (n = 64, P = .002).CONCLUSION: The significantly lower prevalence of cardiac disease in the case group implicates methadone, even at therapeutic levels, as a likely cause of sudden death. These findings point toward an association between methadone and occurrence of sudden death in the community. Clinical safeguards and further prospective studies specifically designed to enhance safety of methadone use are warranted. (C) 2008 Elsevier Inc. All rights reserved.