Bär Karl-Jürgen, Boettger Michael Karl, Boettger Silke, Grotelüschen Marei, Neubauer Rene, Jochum Thomas, Baier Vico, Sauer Heinrich, Voss Andreas
Department of Psychiatry, Friedrich-Schiller-University, Philosophenweg 3, 07743 Jena, Germany.
Drug Alcohol Depend. 2006 Oct 15;85(1):66-74. doi: 10.1016/j.drugalcdep.2006.03.014. Epub 2006 May 2.
Acute alcohol withdrawal is often associated with increased sympathetic activity, and a decreased baroreflex sensitivity (BRS) can be assumed. Parameters of heart rate variability (HRV), blood pressure variability (BPV), BRS as well as cardiac index (CI), left ventricular work index (LVWI) and total peripheral resistance (TPR) were investigated in 20 patients undergoing acute alcohol withdrawal and matched controls. Measures were obtained during the peak of withdrawal symptomatology prior to treatment as well as 2 and 24h under continuous clomethiazole treatment. Alcohol withdrawal scores were obtained and correlated with autonomic measures. In addition, parameters were assessed in 15 subjects who abstained from alcohol after long-term intake. We found a severe down-regulation of BRS during acute alcohol withdrawal and to a milder extent in abstained alcoholics. Furthermore, HRV and BPV did not unequivocally reveal signs of elevated sympathetic activity. Non-linear parameters of HRV and parameters of BRS correlated with the severity of AWS. The distinct decrease of BRS in AWS and in long-term abstained subjects described here is of importance since similar alterations have been identified as independent prognostic factors for cardiac mortality in other diseases.
急性酒精戒断通常与交感神经活动增加有关，可推测压力反射敏感性（BRS）降低。对20例正在进行急性酒精戒断的患者及匹配的对照组研究了心率变异性（HRV）、血压变异性（BPV）、BRS以及心脏指数（CI）、左心室作功指数（LVWI）和总外周阻力（TPR）等参数。在治疗前戒断症状高峰期以及连续使用氯美噻唑治疗2小时和24小时时进行测量。获取酒精戒断评分并与自主神经测量值进行相关性分析。此外，对15例长期饮酒后戒酒的受试者进行了参数评估。我们发现在急性酒精戒断期间BRS严重下调，在戒酒者中下调程度较轻。此外，HRV和BPV并未明确显示交感神经活动增强的迹象。HRV的非线性参数和BRS参数与酒精戒断综合征（AWS）的严重程度相关。本文所述的AWS患者和长期戒酒者中BRS的明显降低具有重要意义，因为在其他疾病中已将类似改变确定为心脏死亡的独立预后因素。
