Mainerova Barbora, Prasko Jan, Latalova Klara, Axmann Karel, Cerna Monika, Horacek Rostislav, Bradacova Romana
Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015 Mar;159(1):44-52. doi: 10.5507/bp.2013.089. Epub 2013 Dec 11.
Delirium tremens represents the most severe complication of alcohol withdrawal syndrome and, in its complications, significantly increases the morbidity and mortality of patients. Alcohol withdrawal delirium is characterized by features of alcohol withdrawal itself (tremor, sweating, hypertension, tachycardia etc.) together with general delirious symptoms such as clouded consciousness, disorientation, disturbed circadian rhythms, thought processe and sensory disturbances, all of them fluctuating in time. The treatment combines a supportive and symptomatic approach. Benzodiazepines in supramaximal doses are usually used as drugs of choice but in some countries such as the Czech Republic or Germany, clomethiazole is frequently used as well.
A computer search of the all the literature published between 1966 and December 2012 was accomplished on MEDLINE and Web of Science with the key words "delirium tremens", "alcohol withdrawal", "treatment" and "pharmacotherapy". There were no language or time limits applied.
When not early recognized and treated adequately, delirium tremens may result in death due to malignant arrhythmia, respiratory arrest, sepsis, severe electrolyte disturbance or prolonged seizures and subsequent trauma. Owing to these possible fatalities and other severe unexpected complications, delirium tremens should be managed at an ICU or wards ensuring vital signs monitoring. In symptomatic treatment, high doses of benzodiazepines, especially lorazepam, diazepam and oxazepam are considered the gold standard drugs. Supportive therapy is also of great importance.
震颤谵妄是酒精戒断综合征最严重的并发症，其并发症会显著增加患者的发病率和死亡率。酒精戒断谵妄的特征是酒精戒断本身的症状（震颤、出汗、高血压、心动过速等）以及一般的谵妄症状，如意识模糊、定向障碍、昼夜节律紊乱、思维过程和感觉障碍，所有这些症状都会随时间波动。治疗采用支持性和对症治疗方法。超最大剂量的苯二氮䓬类药物通常作为首选药物，但在捷克共和国或德国等一些国家，氯美噻唑也经常被使用。
在MEDLINE和科学网对1966年至2012年12月期间发表的所有文献进行计算机检索，关键词为“震颤谵妄”、“酒精戒断”、“治疗”和“药物治疗”。没有应用语言或时间限制。
如果震颤谵妄没有得到早期识别和充分治疗，可能会因恶性心律失常、呼吸骤停、败血症、严重电解质紊乱或长时间癫痫发作及随后的创伤而导致死亡。由于这些可能的死亡和其他严重的意外并发症，震颤谵妄应在重症监护病房或能够监测生命体征的病房进行处理。在对症治疗中，高剂量的苯二氮䓬类药物，尤其是劳拉西泮、地西泮和奥沙西泮被认为是金标准药物。支持性治疗也非常重要。
