Manasco Anton, Chang Shannon, Larriviere Joseph, Hamm L Lee, Glass Marcia
Tulane University School of Medicine, New Orleans, Louisiana 70112, USA.
South Med J. 2012 Nov;105(11):607-12. doi: 10.1097/SMJ.0b013e31826efb2d.
Alcohol withdrawal is a common clinical condition that has a variety of complications and morbidities. The manifestations can range from mild agitation to withdrawal seizures and delirium tremens. The treatments for alcohol withdrawal include benzodiazepines, anticonvulsants, beta-blockers and antihypertensives. Although benzodiazepines are presently a first-line therapy, there is controversy regarding the efficacies of these medications compared with others. Treatment protocols often involve one of two contrasting approaches: symptom-triggered versus fixed-schedule dosing of benzodiazepines. We describe these protocols in our review and examine the data supporting symptom-triggered dosing as the preferred method for most patients in withdrawal.The Clinical Institute Withdrawal Assessment for Alcohol scoring system for alcohol withdrawal streamlines care, optimizes patient management, and is the best scale available for withdrawal assessment. Quality improvement implications for inpatient management of alcohol withdrawal include increasing training for signs of withdrawal and symptom recognition, adding new hospital protocols to employee curricula, and ensuring manageable patient-to-physician and patient-to-nurse ratios.
酒精戒断是一种常见的临床病症，会引发多种并发症和疾病。其表现从轻微躁动到戒断性癫痫发作和震颤谵妄不等。酒精戒断的治疗方法包括苯二氮䓬类药物、抗惊厥药、β受体阻滞剂和抗高血压药。尽管苯二氮䓬类药物目前是一线治疗药物，但与其他药物相比，这些药物的疗效仍存在争议。治疗方案通常采用两种截然不同的方法之一：苯二氮䓬类药物的症状触发给药法与固定时间表给药法。我们在综述中描述了这些方案，并审视了支持症状触发给药法作为大多数戒断患者首选方法的数据。酒精戒断的临床研究所戒断评估评分系统简化了护理流程，优化了患者管理，是现有的最佳戒断评估量表。酒精戒断住院管理的质量改进措施包括加强对戒断体征和症状识别的培训，将新的医院方案纳入员工课程，并确保患者与医生以及患者与护士的比例合理。
