Hospital Internal Medicine, Essentia Health, Duluth, Minnesota 55805-1983, USA.
J Hosp Med. 2011 Oct;6(8):469-74. doi: 10.1002/jhm.928.
Abrupt cessation of alcohol intake causes habituated drinkers to experience symptoms of alcohol withdrawal syndrome (AWS).
To determine the effect of the gamma-aminobutyric acid (GABA)-B agonist baclofen on the course of acute symptomatic AWS.
Prospective, randomized, double-blind, placebo-controlled clinical study.
Two tertiary-care hospitals in Duluth, Minnesota.
Inpatient adults admitted for any reason (including AWS) judged to be at high risk for AWS.
Inpatients who developed symptoms of AWS received symptom-triggered benzodiazepine treatment using lorazepam by standard protocol, and were randomized to receive baclofen 10 mg or placebo, 3 times per day, orally.
AWS severity was assessed using the Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar); lorazepam dose was monitored.
Seventy-nine subjects were enrolled. The 44 subjects who developed symptoms of AWS were randomized to baclofen or placebo. Thirty-one subjects (18 baclofen, 13 placebo) completed 72 hours of assessments, either entirely as inpatients or with outpatient follow-up. The need for high doses of benzodiazepines (20 mg or more of lorazepam over 72 hours) to control AWS was less likely in the baclofen treatment group (1 of 18) than in the placebo-treated group (7 of 13) (P = 0.004).
We found that the use of baclofen was associated with a significant reduction in the use of high doses of benzodiazepine (lorazepam) in the management of symptomatic AWS. The use of low-dose baclofen in the management of AWS deserves further study, as reduced dependence on high-dose benzodiazepines in AWS management could improve patient safety.
突然停止饮酒会使习惯性饮酒者出现酒精戒断综合征（AWS）症状。
确定γ-氨基丁酸（GABA）-B 激动剂巴氯芬对急性症状性 AWS 病程的影响。
前瞻性、随机、双盲、安慰剂对照的临床研究。
明尼苏达州德卢斯的两家三级保健医院。
因任何原因（包括 AWS）住院的成年患者，根据标准协议判断其 AWS 风险高。
出现 AWS 症状的住院患者接受症状触发的苯二氮䓬类药物治疗，使用劳拉西泮，并按标准方案随机接受巴氯芬 10mg 或安慰剂，每日 3 次口服。
使用修订后的临床戒断评估酒精量表（CIWA-Ar）评估 AWS 严重程度；监测劳拉西泮剂量。
共纳入 79 例患者。出现 AWS 症状的 44 例患者被随机分为巴氯芬或安慰剂组。31 例患者（18 例巴氯芬，13 例安慰剂）完成了 72 小时的评估，要么完全住院，要么门诊随访。需要使用高剂量苯二氮䓬类药物（72 小时内 20mg 或更多劳拉西泮）来控制 AWS 的情况，在巴氯芬治疗组（18 例中的 1 例）比安慰剂治疗组（13 例中的 7 例）更少见（P = 0.004）。
我们发现，巴氯芬的使用与减少使用高剂量苯二氮䓬类药物（劳拉西泮）治疗症状性 AWS 显著相关。在 AWS 管理中使用低剂量巴氯芬值得进一步研究，因为减少对高剂量苯二氮䓬类药物在 AWS 管理中的依赖可能会提高患者安全性。
