Wåhlin Sven, Tønnesen Hanne
Beroendecentrum Stockholm - Riddargatan 1 Stockholm, Sweden - Stockholm, Sweden.
- , Sweden - , Sweden.
Lakartidningen. 2014 Oct 28;111(44-45):1966-9.
Increasing evidence points out that alcohol intake is a significant risk factor for patient safety at surgery. This review updates the evidence, mechanisms and recommendations. The threshold is relatively low; about two standard drinks per day or more for two weeks prior to surgery double the complication rate. The mechanisms include reduced immune capacity, sub-clinical cardiomyopathy, haemostatic imbalance, delayed wound healing and increased stress response to surgery. These organ dysfunctions are significantly improved or even normalised during total abstinence from alcohol for 1 to 9 weeks. Only two RCTs has been performed to evaluate the effect of intensive alcohol intervention prior to elective surgery. A 70 % reduction of postoperative complications was shown in a meta-analysis. The intervention targeted complete alcohol cessation, with a high success rate. Research on acute surgery is missing. We recommend that patients are given information on alcohol and increased surgical risk, that alcohol history taking is standardised and that evidence-based intervention programs for risk reduction are included in the surgical guidelines in order to improve the patient safety.
越来越多的证据表明，饮酒是手术患者安全的一个重要风险因素。本综述更新了相关证据、机制和建议。饮酒阈值相对较低；术前两周每天饮用约两杯或更多标准饮品会使并发症发生率加倍。其机制包括免疫能力下降、亚临床心肌病、止血失衡、伤口愈合延迟以及对手术的应激反应增加。在完全戒酒1至9周期间，这些器官功能障碍会得到显著改善甚至恢复正常。仅进行了两项随机对照试验来评估择期手术前强化酒精干预的效果。一项荟萃分析显示术后并发症减少了70%。干预目标是完全戒酒，成功率很高。目前缺少关于急诊手术的研究。我们建议向患者提供有关饮酒与手术风险增加的信息，规范饮酒史询问，并将基于证据的降低风险干预方案纳入手术指南，以提高患者安全性。
