做过肝脏移植手术的患者不需要完全禁止镇静剂的使用
【摘要】发表在《美国内科杂志》上的一篇文章指出：接受过肝脏移植手术的患者一般都要求禁止使用美沙酮类的镇静剂，但是临床研究证明完全没有必要这样做。【全文】Liver transplant should not prevent methadone useBy Suzanne RostlerNEW YORK, Feb 27 (Reuters Health) - Recovering drug addicts who hope to undergo a liver transplant may have an additional burden to overcome: surviving without the help of methadone.According to a report in the February 28th issue of The Journal of the American Medical Association, about one third of liver transplantation programs that accept recovering addicts require these patients to discontinue methadone therapy.But there is no medical justification for this requirement, and stopping methadone treatment can lead to a relapse in as many as 82% of recovering addicts, researchers report. Methadone is an opiate drug that is used, under medical supervision, to ease drug addicts off of narcotics such as heroin."Patients on stable methadone maintenance programs should not be mandated to discontinue prescribed methadone as a precondition for liver transplant list consideration," Dr. Peter Banys from the Veterans Affairs Medical Center in San Francisco, California, said in an interview with Reuters Health."Such a policy may induce relapse in formerly stable patients and then, because of this, may disqualify these patients for surgery," conclude Banys and coauthor Dr. Monika Koch, who is now with Friends' Research Associates in Berkeley, California.The investigators found that all 87 liver transplantation programs surveyed accept patients with a history of substance abuse, but only 56% accept patients on methadone maintenance.Methadone is thought to interact with post-transplant drugs and may affect how the liver metabolizes other drugs.However, none of the programs reported drug interactions with methadone. What's more, "post-transplant patients are routinely maintained on opiates for a period of time for pain management," Banys said."We believe that in the absence of clear evidence that methadone-drug interactions create management problems, there is no...reason to eliminate the chronic opiate administration," Banys said.In other findings, less than 0.5% of nearly 40,500 liver transplantations in the US since 1988 were performed on patients undergoing methadone therapy. Yet, the authors note, hepatitis C and alcoholic liver disease are leading causes of liver transplantation, and both conditions are linked to substance abuse.SOURCE: The Journal of the American Medical Association 2001;285:1056-1058., 百拇医药
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