Lorentzen Kristian, Lauritsen Anne Øberg, Bendtsen Asger Ole
Anæstesiologisk Afdeling Y, Glostrup Hospital, Nordre Ringvej 29-67, 2600 Glostrup, Denmark.
Dan Med J. 2014 May;61(5):A4807.
Delirium tremens is a potentially fatal complication of alcohol withdrawal. In severe delirium, very large dosages of benzodiazepines can be required and in refractory cases, sedation with propofol can be used. Treatment of refractory delirium tremens with propofol is mainly described in case reports. We aimed to evaluate the treatment of delirium tremens with propofol infusion for 48 h.
This study was a single-centre retrospective cohort analysis of 15 patient journals covering the period from May 2012 to September 2013.
Five women and ten men were included. Their mean age was 50.9 years. Prior to propofol treatment, conventional treatment with up to 1,500 mg of benzodiazepines, 2,000 mg of chlordiazepoxide or 1,200 mg of phenobarbital was attempted in the medical or psychiatric ward, without effect (sleep). Patients were sedated, intubated and mechanically ventilated in the intensive care unit. The mean propofol infusion rate was 4.22 mg/kg/h. Thirteen patients received supplemental infusion of opioids, whereas seven required concomitant vasopressor infusion. Once propofol infusion was discontinued after 48 h, 12 patients had a long awakening, displaying symptoms of prolonged sedation. Twelve of the 15 patients treated for delirium tremens with propofol for 48 h were successfully treated. Three patients needed further treatment.
Our study suggests that treatment with propofol is viable. Establishing indication, dose, duration, and long-term effects of propofol treatment of delirium tremens requires further investigation.
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震颤谵妄是酒精戒断可能导致的致命并发症。在严重谵妄状态下，可能需要大剂量的苯二氮䓬类药物，而对于难治性病例，可使用丙泊酚进行镇静。关于使用丙泊酚治疗难治性震颤谵妄的报道主要是病例报告。我们旨在评估丙泊酚持续输注48小时治疗震颤谵妄的效果。
本研究是一项单中心回顾性队列分析，分析了2012年5月至2013年9月期间的15份患者病历。
纳入5名女性和10名男性。他们的平均年龄为50.9岁。在使用丙泊酚治疗前，曾在内科或精神科病房尝试使用高达1500毫克的苯二氮䓬类药物、2000毫克的氯氮䓬或1200毫克的苯巴比妥进行常规治疗，但均无效（未入睡）。患者在重症监护病房接受镇静、插管和机械通气。丙泊酚的平均输注速率为4.22毫克/千克/小时。13名患者接受了补充阿片类药物输注，7名患者需要同时使用血管升压药输注。在48小时后停止丙泊酚输注后，12名患者苏醒时间较长，表现出长时间镇静的症状。15名接受丙泊酚治疗48小时的震颤谵妄患者中有12名成功治愈。3名患者需要进一步治疗。
我们的研究表明丙泊酚治疗是可行的。确定丙泊酚治疗震颤谵妄的适应证、剂量及持续时间以及长期效果，仍需进一步研究。
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