酒精戒断治疗的简化方案。

A Simplified Protocol for the Treatment of Alcohol Withdrawal.

机构信息

Department of Medicine (C.F., E.J., I.S.); Department of Emergency Medicine (H.J.A., R.C.C.); Highland Hospital-Alameda Health System and the Department of Emergency Medicine Kaiser East Bay (M.R.), Oakland, CA; SUNY Downstate College of Medicine (S.S.), Brooklyn, NY; and Department of Medicine, University of California (C.F., H.J.A., I.S.), San Francisco, CA.

出版信息

J Addict Med. 2015 Nov-Dec;9(6):485-90. doi: 10.1097/ADM.0000000000000167.

DOI:10.1097/ADM.0000000000000167

PMID:26501787

Abstract

OBJECTIVES

The aim of the study was to evaluate a novel simplified tool for symptom-triggered treatment of alcohol withdrawal.

METHODS

This retrospective cohort study involved inpatients in a county hospital with an International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis of alcohol withdrawal syndrome (AWS) or delirium tremens between January 1, 2007 and December 31, 2008. The study used the Highland Alcohol Withdrawal Protocol (HAWP)-a simplified derivative of the Revised Clinical Institute Withdrawal Assessment for Alcohol. Multivariable regression analysis was performed to compare severity of withdrawal to hospital length of stay, total dose of sedative given, and risk of complications.

RESULTS

The study identified 442 patients with a primary diagnosis of AWS or delirium tremens, and those with another primary medical diagnosis complicated by alcohol withdrawal. After adjusting for demographic variables, each one-point increase in the initial and maximum HAWP scores correlated with an increase in the hospital length of stay of 0.3 days [95% confidence interval (95% CI), 0.17 to 0.43 days] and 0.45 days (95% CI, 0.32-0.57 days), and a 15.8 mg (95% CI, 6.6-25.1 mg) and 19.8 mg (95% CI, 11.1-28.5 mg) increase in the total dose of lorazepam given, respectively. The complication rate of seizures, intubations, pneumonia, and death was 13.1%, 12.9%, 6.1% and 0.9%, respectively; a composite endpoint of these outcomes also correlated with initial and maximum HAWP scores (odds ratio 1.09, 95% CI, 1.03%-1.14%).

CONCLUSIONS

The HAWP correlates with medication received and complications, and as such appears to give an indication of AWS severity. It is feasible and shorter than prior scales, and merits further study to confirm its effectiveness as part of symptom-triggered protocols to manage alcohol withdrawal in the hospital.

摘要

目的

本研究旨在评估一种新的简化工具，用于酒精戒断症状触发治疗。

方法

本回顾性队列研究纳入了 2007 年 1 月 1 日至 2008 年 12 月 31 日期间在县医院住院的、国际疾病分类，第九修订版，临床修正诊断为酒精戒断综合征（AWS）或震颤谵妄的患者。研究使用高地酒精戒断协议（HAWP）——修订后的临床酒精戒断评估研究所的简化衍生工具。进行多变量回归分析以比较戒断严重程度与住院时间、镇静剂总剂量和并发症风险。

结果

本研究确定了 442 例 AWS 或震颤谵妄的主要诊断患者，以及其他主要医疗诊断伴有酒精戒断的患者。调整人口统计学变量后，初始和最大 HAWP 评分每增加 1 分，住院时间分别增加 0.3 天[95%置信区间（95%CI），0.17-0.43 天]和 0.45 天（95%CI，0.32-0.57 天），劳拉西泮总剂量分别增加 15.8mg（95%CI，6.6-25.1mg）和 19.8mg（95%CI，11.1-28.5mg）。癫痫发作、插管、肺炎和死亡的并发症发生率分别为 13.1%、12.9%、6.1%和 0.9%；这些结局的复合终点也与初始和最大 HAWP 评分相关（比值比 1.09，95%CI，1.03%-1.14%）。