Hack Jason B, Hoffmann Robert S, Nelson Lewis S
New York City Poison Center, NY, NY, USA.
J Med Toxicol. 2006 Jun;2(2):55-60. doi: 10.1007/BF03161171.
While most patients with alcohol withdrawal (AW) respond to standard treatment that includes doses of benzodiazepines, nutrition and good supportive care (non resistant alcohol withdrawal-NRAW), a subgroup may resist therapy (resistant alcohol withdrawal-RAW). This study describes a distinct group of AW patients, their sedative requirements, and hospital courses.
Over a period of 6 months, AW patients requiring 50 mg diazepam IV in the first hour were followed. We recorded admission indices and diazepam doses with vital signs at 1, 2, 3, 6, 12, and 24 hours. Patients were considered to have RAW if they required additional sedatives for control of symptoms and/or were having persistent abnormal vital signs despite the physicians' choices of therapy.
Nineteen patients were enrolled; all had similar admission indices. While the 4 NRAW had normal vital signs within 3 hours, all 15 RAW patients had abnormal vital signs; 15 RAW patients required escalating diazepam doses--14 required barbiturates, 7 were intubated, and 5 had hypotension. Comparing groups: interval and total diazepam doses were not different at 1,2, and 3 hours; interval doses at 6 and 12 hours, and total doses at 6, 12, and 24 hours were significantly different.
RAW patients require large doses of benzodiazepine administration, additional sedatives, and undergo complicated hospitalizations.
虽然大多数酒精戒断（AW）患者对包括苯二氮䓬类药物剂量、营养和良好支持治疗（非耐药性酒精戒断 - NRAW）在内的标准治疗有反应，但有一小部分患者可能对治疗有抵抗（耐药性酒精戒断 - RAW）。本研究描述了一组独特的AW患者、他们的镇静需求以及住院过程。
在6个月的时间里，对首小时需要静脉注射50毫克地西泮的AW患者进行随访。我们记录了入院指标以及1、2、3、6、12和24小时时的生命体征和地西泮剂量。如果患者需要额外的镇静剂来控制症状和/或尽管医生选择了治疗方法但仍有持续异常的生命体征，则被认为患有RAW。
招募了19名患者；他们的入院指标都相似。4名NRAW患者在3小时内生命体征正常，而所有15名RAW患者都有异常生命体征；15名RAW患者需要增加地西泮剂量——14名需要巴比妥类药物，7名需要插管，5名有低血压。组间比较：1、2和3小时时的地西泮间隔剂量和总剂量没有差异；6和12小时时的间隔剂量以及6、12和24小时时的总剂量有显著差异。
RAW患者需要大剂量使用苯二氮䓬类药物、额外的镇静剂，并经历复杂的住院治疗。
