Maxson P M, Schultz K L, Berge K H, Lange C M, Schroeder D R, Rummans T A
Department of Anesthesiology, Mayo Clinic Rochester, MN 55905, USA.
Mayo Clin Proc. 1999 May;74(5):448-53.
To determine whether alcohol abuse or dependence is a risk factor for perioperative complications, increased duration of hospital stay, and increased utilization of nursing resources in patients undergoing thoracic and vascular surgical procedures.
We conducted a prospective study of all adult patients who underwent an elective vascular or thoracic surgical procedure and who received postoperative care in an intensive-care setting. Patients were screened for alcohol abuse or dependence, and actual versus expected durations of stay were evaluated. The patients' medical records were reviewed for preoperative comorbidities and perioperative complications. Fisher's exact test and the rank sum test were used in the analyses.
Of 321 study subjects, 290 were classified as nonalcoholic and 31 as probable alcoholic patients. Patients in the probable alcohol abuse group had a significantly increased rate of alcohol withdrawal (12.9% versus 1.7%; P = 0.006) in comparison with patients in the nonalcoholic group. Patients in the probable alcohol abuse group were readmitted to an intensive-care unit more frequently (19.4% versus 7.9%; P = 0.047) and required sedation more often (32.3% versus 13.5%; P = 0.014) than those in the nonalcoholic group. No significant differences were found between the two study groups in intensive-care unit and hospital durations of stay or in utilization of nursing resources. A dismissal diagnosis of alcoholism was recorded for only one of four patients who had a documented withdrawal episode among those categorized in the probable alcoholic group and for three of five patients with alcohol withdrawal symptoms categorized in the nonalcoholic group.
Except for the occurrence of alcohol withdrawal syndrome, study patients classified in the probable alcohol abuse group did not have more medical or surgical perioperative complications than patients in the nonalcoholic group. They did have significantly more intensive-care setting readmissions. Patients with documented alcohol withdrawal episodes frequently were dismissed without a diagnosis of substance abuse or dependence.
确定酒精滥用或依赖是否是接受胸科和血管外科手术患者围手术期并发症、住院时间延长及护理资源利用增加的危险因素。
我们对所有接受择期血管或胸科手术并在重症监护环境中接受术后护理的成年患者进行了一项前瞻性研究。对患者进行酒精滥用或依赖筛查，并评估实际住院时间与预期住院时间。查阅患者病历以了解术前合并症和围手术期并发症。分析中使用了Fisher精确检验和秩和检验。
在321名研究对象中，290名被归类为非酒精性患者，31名被归类为可能的酒精性患者。与非酒精性组患者相比，可能酒精滥用组患者的酒精戒断率显著增加（12.9%对1.7%；P = 0.006）。可能酒精滥用组患者比非酒精性组患者更频繁地再次入住重症监护病房（19.4%对7.9%；P = 0.047），且更常需要镇静（32.3%对13.5%；P = 0.014）。两组在重症监护病房住院时间、医院住院时间或护理资源利用方面未发现显著差异。在可能酒精性组中记录有戒断发作的4名患者中，只有1名被诊断为酒精中毒，在非酒精性组中出现酒精戒断症状的5名患者中有3名被诊断为酒精中毒。
除出现酒精戒断综合征外，归类为可能酒精滥用组的研究患者在医疗或外科围手术期并发症方面并不比非酒精性组患者更多。他们再次入住重症监护病房的情况确实显著更多。有记录的酒精戒断发作患者经常在未被诊断为药物滥用或依赖的情况下出院。
