Shu Janet E, Lin Austin, Chang Grace
Harvard Medical School, Boston, MA (JES, AL, GC); VA Boston Healthcare System, Brockton, MA (JES, AL, GC); Cambridge Health Alliance, Cambridge, MA (JES)..
Harvard Medical School, Boston, MA (JES, AL, GC); VA Boston Healthcare System, Brockton, MA (JES, AL, GC).
Psychosomatics. 2015 Sep-Oct;56(5):547-55. doi: 10.1016/j.psym.2014.12.002. Epub 2014 Dec 7.
Optimizing alcohol withdrawal treatment is a clinical priority, yet it is difficult to predict on presentation which patients would require benzodiazepines or in which patients withdrawal would be complicated. Detoxification studies typically exclude patients with medical comorbidities, psychiatric comorbidities, or multiple substance use disorders; therefore, it is difficult to generalize their conclusions to all types of patients.
This retrospective study with no exclusion criteria identifies the risk factors for complicated withdrawal.
A retrospective medical record review of 47 veterans admitted to a tertiary veteran's medical hospital for alcohol detoxification. Demographics, blood alcohol level, Charlson Comorbidity Index, drinks per drinking day, pre-psychiatry consult benzodiazepine administration, and length of stay were compared for veterans with complications vs those without.
Overall, 21% patients experienced significant complications during their medically-managed detoxification, including behavioral disruptions and delirium tremens. Of the patients, 79% were initially assessed using the Clinical Institute Withdrawal Assessment for Alcohol-Revised scale, and 34% continued to be monitored with the Clinical Institute Withdrawal Assessment for Alcohol-Revised scale during their hospital stay. A Clinical Institute Withdrawal Assessment for Alcohol-Revised scale score ≥15 at presentation was significantly associated with increased odds of complications (p = 0.005). There was a trend toward significance of association of complications with tachycardia, history of delirium tremens, and benzodiazepines being administered before psychiatric consultation. The groups did not significantly differ with respect to age, admission blood alcohol level, Charlson Comorbidity Index, comorbid recent substance abuse, or length of stay.
Clinical Institute Withdrawal Assessment for Alcohol-Revised scale scores ≥15 at presentation was significantly associated with increased odds of complicated alcohol withdrawal (odds ratio = 28, 95% CI: 2.5-317.6, p = 0.005), which supports findings from previous studies.
优化酒精戒断治疗是临床的一项重要任务，但在就诊时很难预测哪些患者需要使用苯二氮䓬类药物，以及哪些患者的戒断过程会出现并发症。戒毒研究通常会排除患有内科合并症、精神科合并症或多种物质使用障碍的患者；因此，很难将其结论推广到所有类型的患者。
这项无排除标准的回顾性研究旨在确定复杂戒断的危险因素。
对一家三级退伍军人医院收治的47名接受酒精戒毒的退伍军人的病历进行回顾性研究。比较了有并发症和无并发症退伍军人的人口统计学特征、血液酒精水平、查尔森合并症指数、每日饮酒量、精神科会诊前苯二氮䓬类药物的使用情况以及住院时间。
总体而言，21%的患者在药物管理的戒毒过程中出现了严重并发症，包括行为紊乱和震颤谵妄。在这些患者中，79%最初使用修订版酒精戒断临床研究所评估量表进行评估，34%在住院期间继续使用该量表进行监测。就诊时修订版酒精戒断临床研究所评估量表评分≥15与并发症发生几率增加显著相关（p = 0.005）。并发症与心动过速、震颤谵妄病史以及精神科会诊前使用苯二氮䓬类药物之间存在显著关联趋势。两组在年龄、入院血液酒精水平、查尔森合并症指数、近期合并物质滥用或住院时间方面无显著差异。
就诊时修订版酒精戒断临床研究所评估量表评分≥15与复杂酒精戒断发生几率增加显著相关（优势比 = 28，95%可信区间：2.5 - 317.6，p = 0.005），这支持了先前研究的结果。
