Horwitz R I, Gottlieb L D, Kraus M L
Department of Medicine, Yale University School of Medicine, New Haven, CT 06510.
Arch Intern Med. 1989 May;149(5):1089-93.
We conducted a randomized, double-blind, clinical trial of atenolol compared with placebo in the outpatient management of patients with the alcohol withdrawal syndrome. In addition to receiving customary therapy, 88 patients were randomly assigned to receive atenolol and 92 to receive placebo. Outcome during the next 14 days was assessed using two main measures: the patient's clinical course as assessed by an alcohol withdrawal severity index; and the occurrence of treatment failure (composite measure including return to drinking, dropouts, and withdrawal lasting longer than 5 days). In addition, levels of craving for alcohol were assessed as an associated response variable. Overall, treatment failure occurred for 37% of the patients receiving atenolol and 52% of those receiving placebo. Among patients who had withdrawal symptoms at baseline, vital signs became normal more rapidly in the patients receiving atenolol, and their abnormal behavioral characteristics also resolved more rapidly. Levels of craving for alcohol were strongly associated with treatment failure; the group of patients who received atenolol included significantly fewer who reported high levels of craving 24 hours after treatment began (7% of patients receiving atenolol and 20% of those receiving placebo). We conclude that the outpatient management and treatment outcomes of the alcohol withdrawal syndrome are improved in patients who receive atenolol, and that the beneficial effects are associated with reduced levels of craving for alcohol. If these results are confirmed by other investigators, atenolol may prove to play an important role in the outpatient management of the alcohol withdrawal syndrome.
我们进行了一项随机、双盲临床试验，比较阿替洛尔与安慰剂在门诊治疗酒精戒断综合征患者中的效果。除接受常规治疗外，88例患者被随机分配接受阿替洛尔治疗，92例患者接受安慰剂治疗。在接下来的14天内，使用两项主要指标评估结果：通过酒精戒断严重程度指数评估患者的临床病程；以及治疗失败的发生率（综合指标包括复饮、退出研究和戒断持续超过5天）。此外，将对酒精的渴望程度作为一个相关反应变量进行评估。总体而言，接受阿替洛尔治疗的患者中有37%出现治疗失败，接受安慰剂治疗的患者中有52%出现治疗失败。在基线时有戒断症状的患者中，接受阿替洛尔治疗的患者生命体征恢复正常的速度更快，其异常行为特征也更快得到缓解。对酒精的渴望程度与治疗失败密切相关；在开始治疗24小时后，报告有高度渴望的患者在接受阿替洛尔治疗的组中显著较少（接受阿替洛尔治疗的患者中有7%，接受安慰剂治疗的患者中有20%）。我们得出结论，接受阿替洛尔治疗的酒精戒断综合征患者的门诊管理和治疗效果得到改善，且有益效果与对酒精的渴望程度降低有关。如果这些结果得到其他研究者的证实，阿替洛尔可能在酒精戒断综合征的门诊管理中发挥重要作用。
