Department of Pharmacy Practice, Campbell University School of Pharmacy and Health Sciences, P.O. Box 3089, Buies Creek, NC, 27710, USA,
CNS Drugs. 2013 Nov;27(11):913-20. doi: 10.1007/s40263-013-0106-6.
Dexmedetomidine is currently used in the US in the treatment of alcohol withdrawal syndrome (AWS) in the intensive care unit (ICU) setting, although data to support this practice are limited. Dexmedetomidine targets the noradrenergic system, an important but frequently overlooked secondary mechanism in the development of AWS, and, in doing so, may reduce the need for excessive benzodiazepine use which can increase the risk of γ-aminobutyric acid (GABA)-mediated deliriogenesis and respiratory depression. The purpose of this narrative review is to evaluate available literature reporting on the safety and efficacy of dexmedetomidine for AWS in the ICU setting. An English-language MEDLINE search (1966 to July 2013) was performed to identify articles evaluating the efficacy and safety of dexmedetomidine for AWS. Case series, case reports and controlled trials were evaluated for topic relevance and clinical applicability. Reference lists of articles retrieved through this search were reviewed to identify any relevant publications. Studies focusing on the safety and efficacy of dexmedetomidine for AWS in humans were selected. Studies were included if they were published as full articles; abstracts alone were not included in this review. Eight published case studies and case series were identified. Based on a limited body of evidence, dexmedetomidine shows promise as a potentially safe and possibly effective adjuvant treatment for AWS in the ICU. Prospective, well-controlled studies are needed to confirm the safety and efficacy of the use of dexmedetomidine in AWS.
右美托咪定目前在美国 ICU 环境中被用于治疗酒精戒断综合征（AWS），尽管支持这一做法的数据有限。右美托咪定靶向去甲肾上腺素能系统，这是 AWS 发展中一个重要但经常被忽视的次要机制，因此，它可能减少对苯二氮䓬类药物过度使用的需求，过度使用苯二氮䓬类药物会增加 γ-氨基丁酸（GABA）介导的谵妄和呼吸抑制的风险。本叙述性综述的目的是评估现有的关于右美托咪定在 ICU 环境中治疗 AWS 的安全性和疗效的文献。进行了英语 MEDLINE 检索（1966 年至 2013 年 7 月），以确定评估右美托咪定治疗 AWS 的疗效和安全性的文章。评估了病例系列、病例报告和对照试验，以确定其与主题的相关性和临床适用性。通过该检索查阅的文章的参考文献列表也进行了审查，以确定任何相关出版物。选择了关注右美托咪定治疗 AWS 安全性和疗效的人类研究。如果研究作为全文发表，则将其纳入；本综述未包括仅为摘要的研究。确定了 8 项已发表的病例研究和病例系列。基于有限的证据，右美托咪定作为一种可能安全且有效的 AWS 辅助治疗方法在 ICU 中显示出前景。需要前瞻性、良好对照的研究来证实 AWS 中使用右美托咪定的安全性和疗效。
