Opioid detoxification in pregnancy
Opioid detoxification in pregnancy
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DOI：
10.1016/s0029-7844(98)00312-3
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发表时间：
1998-11-01
影响因子：
7.2
通讯作者：
Wendel, GD
中科院分区：
文献类型：
--
作者：
Dashe, JS;Jackson, GL;Wendel, GD
目的：阿片类药物戒断与胎儿生长不良、早产和胎儿死亡有关。我们试图评估产前阿片类药物戒毒的安全性，在选定的孕妇，方法：1990年至1996年，妇女与单胎妊娠谁报告阿片类药物使用提供住院戒毒。进行脱毒前超声检查以确定胎龄，并排除生长受限和羊水过少的胎儿。有轻度戒断症状的妇女最初给予可乐定，如果症状持续，则用美沙酮替代。戒断的客观迹象从一开始就用美沙酮治疗。一旦妊娠达到24周，就进行产前检查，观察新生儿是否有新生儿戒断综合征的体征，并在必要时进行治疗。产科和新生儿的结局datasecollowed.Results：34孕妇选择接受阿片类药物脱毒，平均胎龄为24周。美沙酮的中位最大剂量为每天20毫克（范围10-85毫克），中位戒毒时间为12天（范围3-39天）。总体而言，20名妇女（59%）成功戒毒，没有复发，10名（29%）恢复产前阿片类药物使用，4名（12%）没有完成戒毒，选择美沙酮维持。脱毒期间无胎儿窘迫迹象，无胎儿死亡，36周前无分娩。15%的新生儿接受了麻醉品戒断治疗。结论：在选定的患者中，阿片类药物脱毒可以在妊娠期间安全完成。（Obstet Gynecol 1998;92：854-8，（C）1998 by The American College of Obstetricians and Gynecologists.）.
Objective: Opioid withdrawal has been associated with poor fetal growth, preterm delivery, and fetal death. We sought to evaluate the safety of antepartum opioid detoxification in selected gravidas,Methods: Between 1990 and 1996, women with singleton gestations who reported opioid use were offered inpatient detoxification. Predetoxification sonography was performed to confirm gestational age and to exclude fetuses with growth restriction and oligohydramnios. Women with mild withdrawal symptoms were given clonidine initially and methadone was substituted if symptoms persisted. Objective signs of withdrawal were treated with methadone from the outset. Antenatal testing was performed once gestations reached 24 weeks, Newborns were observed for signs of neonatal abstinence syndrome and were treated as necessary. Obstetric and neonatal outcome data were collected.Results: Thirty-four gravidas elected to undergo opioid detoxification at a mean gestational age of 24 weeks. The median maximum dose of methadone was 20 mg per day (range 10-85 mg), and the median time to detoxification was 12 days (range 3-39 days). Overall, 20 women (59%) successfully underwent detoxification and did not relapse, ten (29%) resumed antenatal opioid use, and four (12%) did not complete detoxification and opted for methadone maintenance. There was no evidence of fetal distress during detoxification, no fetal death, and no delivery before 36 weeks. Fifteen percent of neonates were treated for narcotic withdrawal.Conclusion: In selected patients, opioid detoxification can be accomplished safely during pregnancy. (Obstet Gynecol 1998;92:854-8, (C) 1998 by The American College of Obstetricians and Gynecologists.).