Mo Yoonsun, Thomas Michael C, Karras George E
Department of Pharmacy Practice, Western New England University College of Pharmacy, 1215 Wilbraham Road, Springfield, MA 01119; Mercy Medical Center, 271 Carew Street, Springfield, MA 01104.
Department of Pharmacy Practice, Western New England University College of Pharmacy, 1215 Wilbraham Road, Springfield, MA 01119.
J Crit Care. 2016 Apr;32:101-7. doi: 10.1016/j.jcrc.2015.11.022. Epub 2015 Dec 8.
To perform a systematic review of the clinical trials concerning the use of barbiturates for the treatment of acute alcohol withdrawal syndrome (AWS).
A literature search of MEDLINE, EMBASE, and the Cochrane Library, together with a manual citation review was conducted. We selected English-language clinical trials (controlled and observational studies) evaluating the efficacy and safety of barbiturates compared with benzodiazepine (BZD) therapy for the treatment of AWS in the acute care setting. Data extracted from the included trials were duration of delirium, number of seizures, length of intensive care unit and hospital stay, cumulated doses of barbiturates and BZDs, and respiratory or cardiac complications.
Seven studies consisting of 4 prospective controlled and 3 retrospective trials were identified. Results from all the included studies suggest that barbiturates alone or in combination with BZDs are at least as effective as BZDs in the treatment of AWS. Furthermore, barbiturates appear to have acceptable tolerability and safety profiles, which were similar to those of BZDs in patients with AWS.
Although the evidence is limited, based on our findings, adding phenobarbital to a BZD-based regimen is a reasonable option, particularly in patients with BZD-refractory AWS.
对关于使用巴比妥类药物治疗急性酒精戒断综合征（AWS）的临床试验进行系统评价。
检索了MEDLINE、EMBASE和Cochrane图书馆，并进行了人工文献回顾。我们选择了英文的临床试验（对照研究和观察性研究），评估在急性护理环境中，与苯二氮䓬（BZD）疗法相比，巴比妥类药物治疗AWS的疗效和安全性。从纳入试验中提取的数据包括谵妄持续时间、癫痫发作次数、重症监护病房和住院时间、巴比妥类药物和BZD的累积剂量以及呼吸或心脏并发症。
共确定了7项研究，包括4项前瞻性对照试验和3项回顾性试验。所有纳入研究的结果表明，单独使用巴比妥类药物或与BZD联合使用在治疗AWS方面至少与BZD一样有效。此外，巴比妥类药物似乎具有可接受的耐受性和安全性，在AWS患者中与BZD相似。
尽管证据有限，但根据我们的研究结果，在基于BZD的治疗方案中添加苯巴比妥是一个合理的选择，特别是在对BZD难治的AWS患者中。
