酒精戒断综合征的识别与管理
Identification and management of alcohol withdrawal syndrome.
作者信息
Mirijello Antonio, D'Angelo Cristina, Ferrulli Anna, Vassallo Gabriele, Antonelli Mariangela, Caputo Fabio, Leggio Lorenzo, Gasbarrini Antonio, Addolorato Giovanni
机构信息
Alcohol Use Disorders Unit, Department of Internal Medicine, Institute of Internal Medicine, Gemelli Hospital, Catholic University of Rome, Largo Gemelli 8, 00168, Rome, Italy.
出版信息
Drugs. 2015 Mar;75(4):353-65. doi: 10.1007/s40265-015-0358-1.
Symptoms of alcohol withdrawal syndrome (AWS) may develop within 6-24 h after the abrupt discontinuation or decrease of alcohol consumption. Symptoms can vary from autonomic hyperactivity and agitation to delirium tremens. The gold-standard treatment for AWS is with benzodiazepines (BZDs). Among the BZDs, different agents (i.e., long-acting or short-acting) and different regimens (front-loading, fixed-dose or symptom-triggered) may be chosen on the basis of patient characteristics. Severe withdrawal could require ICU admission and the use of barbiturates or propofol. Other drugs, such as α2-agonists (clonidine and dexmetedomidine) and β-blockers can be used as adjunctive treatments to control neuroautonomic hyperactivity. Furthermore, neuroleptic agents can help control hallucinations. Finally, other medications for the treatment for AWS have been investigated with promising results. These include carbamazepine, valproate, sodium oxybate, baclofen, gabapentin and topiramate. The usefulness of these agents are discussed.
酒精戒断综合征(AWS)的症状可能在突然停止饮酒或减少饮酒量后的6 - 24小时内出现。症状从自主神经功能亢进和激越到震颤谵妄不等。AWS的金标准治疗方法是使用苯二氮䓬类药物(BZDs)。在BZDs中,可根据患者特征选择不同的药物(即长效或短效)和不同的治疗方案(负荷给药、固定剂量或症状触发)。严重戒断可能需要入住重症监护病房并使用巴比妥类药物或丙泊酚。其他药物,如α2激动剂(可乐定和右美托咪定)和β受体阻滞剂,可作为辅助治疗来控制神经自主功能亢进。此外,抗精神病药物有助于控制幻觉。最后,已对其他用于治疗AWS的药物进行了研究,结果很有前景。这些药物包括卡马西平、丙戊酸盐、γ-羟基丁酸钠、巴氯芬、加巴喷丁和托吡酯。本文讨论了这些药物的效用。