高剂量加巴喷丁治疗严重酒精戒断综合征：回顾性队列分析。

High-Dose Gabapentin for the Treatment of Severe Alcohol Withdrawal Syndrome: A Retrospective Cohort Analysis.

机构信息

Department of Pharmacy Practice, University of Saint Joseph School of Pharmacy & Physician Assistant Studies, Hartford, Connecticut.

Department of Pharmacy, Saint Francis Hospital and Medical Center, Hartford, Connecticut.

出版信息

Pharmacotherapy. 2019 Sep;39(9):881-888. doi: 10.1002/phar.2309. Epub 2019 Jul 22.

DOI:10.1002/phar.2309

PMID:31278761

Abstract

STUDY OBJECTIVE

Gabapentin has been proved to be beneficial in promoting abstinence, decreasing alcohol cravings, and improving mood and sleep quality when given at higher doses; however, data are limited regarding the efficacy and safety of using high-dose gabapentin as part of the treatment of alcohol withdrawal syndrome (AWS). The aim of this study was to evaluate the impact of high-dose gabapentin on benzodiazepine requirements, alcohol withdrawal symptoms, and hospital length of stay in patients hospitalized with AWS.

DESIGN

Retrospective cohort study.

SETTING

Large academic medical center.

PATIENTS

All adults presenting to the emergency department between January 2015 and April 2018 with a diagnosis of severe AWS (Clinical Institute Withdrawal Assessment for Alcohol Scale, Revised [CIWA-Ar] score ≥ 15) and prescribed the institution's alcohol withdrawal agitated delirium protocol were eligible for inclusion in the study. Of these, 50 patients who received high-dose gabapentin (≥ 1800 mg/day) in the first 48 hours of hospital admission (treatment group) were propensity score-matched to 50 patients who did not receive gabapentin (control group).

MEASUREMENTS AND MAIN RESULTS

Patients who received high-dose gabapentin required a significantly lower overall amount of benzodiazepines (mean ± SD 109.5 ± 53.4 mg vs 88.5 ± 35.6 mg [lorazepam equivalents], p=0.023) and had a significantly lower mean CIWA-Ar score (10.1 ± 4.7 vs 7.7 ± 3.9, p=0.010) and maximum CIWA-Ar score (16.0 ± 7.0 vs 12.6 ± 6.1, p=0.016) on day 3 of hospitalization. The high-dose gabapentin regimen was well tolerated, without an increased risk of oversedation, compared with the control group (Richmond Agitation-Sedation Scale score < -1: 34% in the treatment group vs 20% in the control group, p=0.115). Patients receiving high-dose gabapentin had a shorter length of hospital stay (7.4 ± 4.0 days vs 6.0 ± 2.6 days, p=0.034) and increased likelihood of being discharged home (66% vs 88%, p=0.009) compared with the control group.

CONCLUSION

Early initiation of high-dose gabapentin was associated with a significant reduction in benzodiazepine exposure, faster stabilization of alcohol withdrawal-related symptoms, and shorter hospital length of stay. Future studies evaluating gabapentin's effect on long-term safety and hospital readmission are warranted.

摘要

研究目的

高剂量加巴喷丁已被证明在促进戒断、减少酒精渴求以及改善情绪和睡眠质量方面具有益处，当剂量较高时；然而，关于高剂量加巴喷丁作为酒精戒断综合征（AWS）治疗的一部分的疗效和安全性的数据有限。本研究旨在评估高剂量加巴喷丁对苯二氮䓬类药物需求、酒精戒断症状和住院时间的影响，用于治疗 AWS 的住院患者。

设计

回顾性队列研究。

地点

大型学术医疗中心。

患者

所有在 2015 年 1 月至 2018 年 4 月期间因严重 AWS（修订后的临床戒断评估酒精量表[CIWA-Ar]评分≥15）到急诊科就诊并接受该机构酒精戒断激越性谵妄方案治疗的成年人均符合入组条件。其中，50 名在入院后 48 小时内接受高剂量加巴喷丁（≥1800mg/天）的患者（治疗组）与 50 名未接受加巴喷丁治疗的患者（对照组）进行了倾向评分匹配。

测量和主要结果

接受高剂量加巴喷丁治疗的患者需要的总苯二氮䓬类药物量明显减少（平均±SD，109.5±53.4mg vs 88.5±35.6mg[劳拉西泮当量]，p=0.023），并且住院第 3 天的平均 CIWA-Ar 评分（10.1±4.7 与 7.7±3.9，p=0.010）和最大 CIWA-Ar 评分（16.0±7.0 与 12.6±6.1，p=0.016）均显著降低。与对照组相比，高剂量加巴喷丁方案耐受性良好，无过度镇静风险增加（Richmond 激越-镇静量表评分<-1：治疗组 34%，对照组 20%，p=0.115）。接受高剂量加巴喷丁治疗的患者住院时间更短（7.4±4.0 天与 6.0±2.6 天，p=0.034），更有可能出院回家（66%与 88%，p=0.009）。