Effect Of Opium Drugs (Narcotics) On Peripheral Nerves: Report 2 Cases

Objective: To discuss the pathonegesis, clinical characteristics, treatmennt and prognois on brachial paralysist induced by the drug adicts. Method: To have a retrospective analysis and summarize the clinical materials of these two cases. Results: the clinical features show that each branch of the peripheral nerve was injured, with pathological changes spreading all the limbs, while the effect of the treatment is not very good. Discussion: with the spreading of the drug, there are more and more reports that the drugs injure each system of the body. The opioids mainly damage the central nervous system, endocrine system and immune system, but few reports appeared on peripheral nerve system. With the awareness of danger of the drugs , the academia began to focus on this issue. The clinical features of this disease are as follows: each branch of the peripheral nerve was involved, pathological changes cover all the limbs, with the bad result of the treatment. This disease is unwonted and the pathonegesis is still unclear. At present, prevention and heteropathy are the main measures. Pathonegesis: Heroin may cause the pathological changes of the peripheral nerve through the following ways, thereby influence the conductive function. Leading to nervous demyelination: clinical and experimental research show that with the increase of pathological concentrations, of such substances as: oxygen free radicel, lipid-peroxides(LPO) and its metabolites etc. can react with protein, lipide, sugar, enzyme and nucleic acid directly, destroy the structure of cell and subcellular such as lysosomes and mitochondria,which caused the transformation of membrane permeability and led to the nervous demyelination. Through electron microscope., we canfind that the vacuoles came into being in the myelination which was during the split of peripheral nervous cell with the action of heroin. Heroin can increase the levels of pathological concentrations, liped-peroxides(LPO) and its metabolites. Heroin can reduce the level of vitamC vitamE and β-car in the blood, which are the important antioxidant, delete superoxideanion free radicals(SAFR) and hydrogen peroxide etc, accordingly protected the cellular membrane. The decrease of the levels of vitamC vitamE andβ-car carotene in the blood can cause the pathological acceleration of free radice action and peroxide reaction, leading to nervous demyelination. Great amounts of heroin can change the catecholamine, strengthen the catecholamine auto-oxidation, then produce plenty of oxygen and induce the pathological acceleration of free radice action, peroxide reaction and liped-peroxides(LPO) reaction.Large dose of opioids can have the anaesthetic effect, resulting in narcoma. In some cases, people doped off and fell down, after injected overdose heroin intravenousiy. The limbs were compressed for so long time that the tissues swelled, subsequently inducing the neurological microcirculation disorder. Inversible nervous demyelination reaction can be caused by ischemia for long time. Meanwhile, if released from the compression of the limbs, the resumption of vertebrobasilar again cause the focal tissue ischemic injury of reprefusion, with the result of the aggravation of nervous demyelination. Decrease nerve compliance: Peripheral nevers are characterised by the fact that it can move of lateral and lognitudinal in the directions and can sustain outside force caused by cushion, squeeze, bump, pull, and shorten. Heroin can affect the blood supply of peripheral nerve, and make the localepineurium thick and then adhere to peripheral tissue, which can impede nerve longitudinal movement. Because the adhesion is comparatively fixed, a secondary strain nerve injury. Will come into being. Have an effect on neuron: Heroin can inhibit axon growth , as well as interneuron at the edge of the dorsal horn of the spinal cord, substantia gelatinosa and layer V of gray matter., which thereby have an effect on upper tracts which are mainly spinothalamic tracts. Heroin can also directly inhibit down tract of posterior funiculus of spinal cord. The factors described above have a synergistic effect on brachial plexus and affect their conductive function. Destroy blood-nerve barrier: Peripheral nerve has the same barrier system as blood-brain barrier. The latter was found to have leakage in the endothelial cell of capillary endoneurium duringthe ischemia of peripheral nerves, which results in lacuna space syndrome in the peripheral nerve. It further has an effect on the conductive function. Drug allergy and hypersensitivity reaction caused by opiates also have an influence on the conductive function. Clinical diagnosis: The patients has an obvious history of drug abuse, with neither history of injury nor compression. It was found that there was anesthesia in four limbs in the early stage, flaccid paralysis in the late stage. The fact that lack of other obvious positive sign. Symptoms easily covered others of central nervous system. Neglection by patients and physicians would easily lead to the result of an early diagnosis. Electromyography can detect the early pathological changes in the peipheral nerve. It should be noted that it should be differentiated from bone fascia compartment syndrome, peripheral nerve compressionsyndrome, peripheral nerve injury caused by injection. Treatment and prognosis: Drug has a serious effect on peripheral nerve. It was reported that the symptoms naturally disappear if stopping abuse at the early stage of peripheral nerve injury. Once there was nerve dysfunction, it will be irreversible. The result will be not good whether it was treated by loose solution surgery, and nerve nutrition. There have not been effective methods to treat pathological changes of peripheral nerve caused by opiates. Therefore,at present the most effective approach to decrease the incidence of this disease is to popularize the knowledge about abuse hazards, and to improve the disease understanding among patients and physicians., with the result of prevention them from touching drug and to make the addicts give up drug. Conclusion: According to the available data, the...