rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2017-3-48-63rmt-1592Research ArticleОБЗОРЫ И КРАТКИЕ СООБЩЕНИЯREVIEWS & SHORT COMMUNICATIONSОстрые отравления метадоном (дольфином) (обзор)Acute Poisoning with Methadone (Dolphin) (Review)ЛивановГ. А.LivanovGeorgy A.

192242, г. Санкт-Петербург, ул. Будапештская, д. 3

3 Budapeshtskaya Str., Saint-Petersburg 192242

ЛоладзеА. Т.LoladzeAlexander T.

192242, г. Санкт-Петербург, ул. Будапештская, д. 3

3 Budapeshtskaya Str., Saint-Petersburg 192242

БатоцыреновБ. В.BatotsyrenovBair V.

192242, г. Санкт-Петербург, ул. Будапештская, д. 3

3 Budapeshtskaya Str., Saint-Petersburg 192242

bbair@mail.ruЛодягинА. Н.LodyaginAlexey N.

192242, г. Санкт-Петербург, ул. Будапештская, д. 3

3 Budapeshtskaya Str., Saint-Petersburg 192242

ГлушковС. И.GlushkovSergey I.

192242, г. Санкт-Петербург, ул. Будапештская, д. 3

3 Budapeshtskaya Str., Saint-Petersburg 192242

ХаритоноваТ. В.KharitonovaTatiana V.

192242, г. Санкт-Петербург, ул. Будапештская, д. 3

3 Budapeshtskaya Str., Saint-Petersburg 192242

ИвановаА. А.IvanovaAlexandra A.

192242, г. Санкт-Петербург, ул. Будапештская, д. 3

3 Budapeshtskaya Str., Saint-Petersburg 192242

БарановД. В.BaranovDmitry V.

192242, г. Санкт-Петербург, ул. Будапештская, д. 3

3 Budapeshtskaya Str., Saint-Petersburg 192242

АнтоноваА. М.AntonovaAnna M.

192242, г. Санкт-Петербург, ул. Будапештская, д. 3

3 Budapeshtskaya Str., Saint-Petersburg 192242

Санкт-Петербургский НИИ скорой помощи им. И. И. ДжанелидзеРоссияI. I. Dzhanelidze Saint-Petersburg Research Institute of Emergency MedicineRussian Federation2017300620171334863Copyright © Ливанов Г.А., Лоладзе А.Т., Батоцыренов Б.В., Лодягин А.Н., Глушков С.И., Харитонова Т.В., Иванова А.А., Баранов Д.В., Антонова А.М., 20172017Ливанов Г.А., Лоладзе А.Т., Батоцыренов Б.В., Лодягин А.Н., Глушков С.И., Харитонова Т.В., Иванова А.А., Баранов Д.В., Антонова А.М.Livanov G.A., Loladze A.T., Batotsyrenov B.V., Lodyagin A.N., Glushkov S.I., Kharitonova T.V., Ivanova A.A., Baranov D.V., Antonova A.M.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/1592

В мировой литературе имеются данные об опыте применения метадона, в основном, как лекарственного средства, однако в последние годы во всем мире отмечается рост нелегального использования метадона, в связи с чем расчет число госпитализируемых с острыми отравлениями этим синтетическим опиоидом. Цель настоящего обзора -представление современных данных о механизмах токсического действия, избирательной токсичности, токсикокинетике и токсикодинамике метадона (дольфина). В обзоре рассмотрены поражения ЦНС, дыхательной, сердечно-сосудистой и мочевыделительной систем при острых отравлениях метадоном. Анализировано использование метадона в ряде стран как лекарственного средства «заместительной» терапии при опиатной наркотической зависимости. Показано, что результаты использования антидотной терапии налоксоном при острых отравлениях опиоидами не всегда однозначно свидетельствуют о его достаточной эффективности. Дано обоснование направлений совершенствования интенсивной терапии тяжелых форм острых отравлений метадоном путем использования, помимо общереаниматологических мероприятий, комплексного метаболического антигипоксанта цитофлавина. 

Most publications report on the use of methadone as a medication, however an increase of the illegal use of methadone has been demonstrated worldwide over the recent years, thus increasing the number of hospitalizations due to acute poisoning with this synthetic opioid. The aim of the present review was to summarize current data on the mechanisms of toxicity, selective toxicity, toxicokinetics and toxicodynamics of methadone (Dolphin). The involvement of CNS, respiratory, cardiovascular and urinary systems in acute poisoning with methadone was dis- cussed. The practice of use of methadone in many countries as a medicine for the replacement therapy for opiate addicts was analyzed. In addition, it was suggested that the results of the use of naloxone antidote therapy in acute opioid poisoning do not always clearly demonstrate its sufficient efficacy. Ways to improve of the intensive therapy of severe acute poisoning by methadone were substantiated; in addition to general critical care methods, treatment with a complex metabolic antihypoxant cytoflavin should be considered. 

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The authors declare that there are no conflicts of interest present.