Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA 23298-0050, USA.
Chest. 2010 Oct;138(4):994-1003. doi: 10.1378/chest.09-1425.
Alcohol abuse and dependence, referred to as alcohol-use disorders (AUDs), affect 76.3 million people worldwide and account for 1.8 million deaths per year. AUDs affect 18.3 million Americans (7.3% of the population), and up to 40% of hospitalized patients have AUDs. This review discusses the development and progression of critical illness in patients with AUDs. In contrast to acute intoxication, AUDs have been linked to increased severity of illness in a number of studies. In particular, surgical patients with AUDs experience higher rates of postoperative hemorrhage, cardiac complications, sepsis, and need for repeat surgery. Outcomes from trauma are worse for patients with chronic alcohol abuse, whereas burn patients who are acutely intoxicated may not have worse outcomes. AUDs are linked to not only a higher likelihood of community-acquired pneumonia and sepsis but also a higher severity of illness and higher rates of nosocomial pneumonia and sepsis. The management of sedation in patients with AUDs may be particularly challenging because of the increased need for sedatives and opioids and the difficulty in diagnosing withdrawal syndrome. The health-care provider also must be watchful for the development of dangerous agitation and violence, as these problems are not uncommonly seen in hospital ICUs. Despite studies showing that up to 40% of hospitalized patients have AUDs, relatively few guidelines exist on the specific management of the critically ill patient with AUDs. AUDs are underdiagnosed, and a first step to improving patient outcomes may lie in systematically and accurately identifying AUDs.
酒精滥用和依赖，称为酒精使用障碍（AUDs），影响全球 7630 万人，每年导致 180 万人死亡。AUDs 影响 1830 万美国人（占人口的 7.3%），多达 40%的住院患者有 AUDs。这篇综述讨论了 AUDs 患者发生危重病的发展和进展。与急性中毒不同，一些研究表明 AUDs 与疾病严重程度的增加有关。特别是，有 AUDs 的手术患者术后出血、心脏并发症、败血症和需要再次手术的发生率更高。慢性酒精滥用的创伤患者的预后更差，而急性中毒的烧伤患者的预后可能不会更差。AUDs 不仅与社区获得性肺炎和败血症的更高发生率有关，而且与疾病的更严重程度以及医院获得性肺炎和败血症的更高发生率有关。由于需要更多的镇静剂和阿片类药物，以及诊断戒断综合征的难度，AUDs 患者的镇静管理可能特别具有挑战性。医疗保健提供者还必须警惕危险的激越和暴力的发生，因为这些问题在医院 ICU 中并不罕见。尽管研究表明多达 40%的住院患者有 AUDs，但关于 AUDs 危重患者的具体管理，相对较少有指南。AUDs 被漏诊，改善患者预后的第一步可能在于系统和准确地识别 AUDs。
