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γ-羟基丁酸的依赖和戒断

Authors
Deborah L Zvosec, PhD
Stephen W Smith, MD
Section Editors
Stephen J Traub, MD
Michele M Burns, MD, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM
Translators
谌红献, 教授

引言

γ-羟基丁酸(gamma hydroxybutyrate, GHB)是一种有致欣快、致兴奋、镇静及提高性欲的作用而被滥用的药物。γ-丁内酯(gamma butyrolactone, GBL)和1,4-丁二醇(butanediol, BD)是GHB的衍生物或前体，当它们被机体摄入后会很快代谢为GHB而产生与GHB相同的临床效应。GHB、GBL和BD这三种化合物因其所谓的健康益处(包括健美，治疗失眠、焦虑和酒精依赖)，被用作膳食“补充剂”。据报道，因消遣及所谓的健康益处而使用GHB、GBL和BD的个体出现了对药物的耐受、心理及躯体依赖，以及戒断。[1-9]。

GHB在美国和欧洲也用作治疗性药物。在美国，GHB的商品名为Xyrem®(羟丁酸钠)，该药已被美国食品药品监督管理局(Food and Drug Administration, FDA)批准用于治疗发作性睡病伴猝倒和/或白天睡眠过多。在欧洲，GHB的商品名为Xyrem®和Alcover®，已研究了其治疗酒精及药物依赖的情况，GHB的商品名还有Somsanit®，该药已被批准为麻醉药。已有报道称，在密切监督下给予GHB/Alcover®的治疗性试验中，患者出现对药物的渴求、滥用、依赖和戒断[10-12]，采用Xyrem®治疗的试验也有这些现象[13,14]。  

GHB戒断的临床特征及治疗总结在此。GHB急性中毒及其治疗，以及中毒患者的一般处理方法将在别处讨论。 (参见“Gamma hydroxybutyrate (GHB) intoxication”和“成人药物中毒的一般处理方法”)

本专题中，除非有特别说明，我们均使用术语“GHB”指代GHB及其类似物(GBL和BD)。GHB及其类似物的药理学将单独讨论。 (参见“Gamma hydroxybutyrate (GHB) intoxication”, section on ‘Pharmacology and cellular toxicology’)

流行病学

由于缺乏监管和系统报告机制，我们对慢性GHB滥用或依赖的患病率知之甚少。在美国、加拿大、欧洲和澳大利亚，已有GHB依赖和戒断的病例报道[1-8,15-21]。

                                 

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Literature review current through: 2017-07 . | This topic last updated: 2012-08-07.
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