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甲基苯丙胺中毒

Authors
Edward W Boyer, MD, PhD
Christina Hernon, MD
Section Editors
Stephen J Traub, MD
Michele M Burns, MD, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM

引言

甲基苯丙胺是一种拟交感神经胺类，属于苯乙胺类化合物，具有导致兴奋、厌食、欣快和幻觉等多种刺激作用。甲基苯丙胺于1893年被首次合成。30年之后，甲基苯丙胺作为药品成分被用于鼻充血和哮喘的治疗。第二次世界大战期间，德国、日本和美国的军队广泛使用甲基苯丙胺以提高士兵的警觉性并减少疲劳。

甲基苯丙胺在临床上用于注意缺陷多动障碍(attention deficit disorder with hyperactivity, ADHD)的治疗、肥胖的短期治疗以及发作性嗜睡病的超适应证治疗。在美国、南亚、菲律宾和日本，娱乐性使用甲基苯丙胺和其它苯丙胺衍生物兴奋剂已呈流行状态。甲基苯丙胺是除大麻外，世界上最为广泛滥用的毒品[1]。大约5%的美国人使用过甲基苯丙胺，在任意一个月中，估计都有约500,000美国人使用过甲基苯丙胺[2-5]。

通过容易获得的化学制品与非处方类感冒药(如麻黄碱和伪麻黄碱)之间的简单反应，就可以合成甲基苯丙胺。虽然有些非法甲基苯丙胺是药物产品转制而来，但大部分娱乐性甲基苯丙胺是专门为非法使用而生产的。以前美国非法甲基苯丙胺产量主要来自农村地区数以千计的小实验室，如今这些小实验室已经被产量以千克计的“超级实验室”所取代。秘密合成甲基苯丙胺会有引发爆炸和毒物暴露的风险，是引起许多儿童发生毒性产品严重暴露的原因[6]。

本专题将讨论急性甲基苯丙胺中毒的毒理学、诊断和处理。急性用药过量的一般处理以及其他兴奋剂(如可卡因)的治疗将在别处讨论。 (参见“成人药物中毒的一般处理方法”和“可卡因：急性中毒”)

药理学与细胞毒理学

苯乙胺类包含一组中枢神经系统(central nervous system, CNS)兴奋剂组成(图 1)。在苯乙胺基本结构上的不同取代基决定了所生成化合物的CNS穿透性、被单胺氧化酶(monoamine oxidase, MAO)分解的可能性、与受体结合的 亲和力以及作用范围。

                          

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-06.
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