Division of Psychosocial Oncology - Swedish Cancer Institute, Swedish Medical Center, Seattle, WA.
Addiction Consult Service, Avery D. Weismann, Psychiatry Consultation Service, Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA.
Psychosomatics. 2020 Jul-Aug;61(4):327-335. doi: 10.1016/j.psym.2020.01.008. Epub 2020 Feb 8.
Alcohol withdrawal syndrome (AWS) in surgical trauma patients is associated with significant morbidity and mortality. Benzodiazepines, commonly used for withdrawal management, pose unique challenges in this population given the high prevalence of head trauma and delirium. Phenobarbital is an antiepileptic drug that offers a viable alternative to benzodiazepines for AWS treatment.
This is a retrospective chart review of patients with active alcohol use disorder who presented to a level 1 trauma center over a 4-year period and required medication-assisted management for AWS. The primary outcome variable examined was the development of AWS and associated complications. Additional outcomes measured included hospital length of stay, mortality, and medication-related adverse events.
Of the 85 patients in the study sample, 52 received a fixed-dose benzodiazepine-based protocol and 33 received phenobarbital-based protocol. In the benzodiazepine-based protocol group, 25 patients (48.2%) developed AWD and 38 (73.1%) developed uncomplicated AWS, as compared to 0 patients in the phenobarbital-based protocol (P = 0.0001). There were 10 (19.2%) patients with medication adverse side effects in the benzodiazepine-based protocol group versus 0 patients in the phenobarbital-based protocol group. There were no statically significant differences between the 2 groups as pertains to rates of other AWS-related complications, patient mortality, or length of stay.
The use of a phenobarbital-based protocol in trauma patients with underlying active alcohol use disorder resulted in a statistically significant decrease in the incidence of AWD and uncomplicated AWS secondary to AWS when compared to patients treated with a fixed-dose benzodiazepine-based protocol.
手术创伤患者的酒精戒断综合征（AWS）与显著的发病率和死亡率相关。苯二氮䓬类药物常用于戒断管理，但由于头部创伤和谵妄的高患病率，在该人群中使用时存在独特的挑战。苯巴比妥是一种抗癫痫药物，为 AWS 治疗提供了一种可行的苯二氮䓬类药物替代方案。
这是一项对在 4 年内因 AWS 而到 1 级创伤中心就诊且需要药物辅助管理的活跃酒精使用障碍患者的回顾性图表审查。检查的主要结果变量是 AWS 的发展及其相关并发症。测量的其他结果包括住院时间、死亡率和与药物相关的不良事件。
在研究样本中的 85 名患者中，52 名患者接受了固定剂量的苯二氮䓬类药物方案治疗，33 名患者接受了苯巴比妥类药物方案治疗。在苯二氮䓬类药物方案组中，25 名患者（48.2%）出现了 AWS，38 名患者（73.1%）出现了无并发症的 AWS，而在苯巴比妥类药物方案组中没有患者出现这种情况（P=0.0001）。苯二氮䓬类药物方案组中有 10 名（19.2%）患者出现药物不良反应，而苯巴比妥类药物方案组中没有患者出现这种情况。两组在 AWS 相关并发症、患者死亡率或住院时间方面没有统计学上的显著差异。
与使用固定剂量苯二氮䓬类药物方案治疗的患者相比，在患有潜在活跃酒精使用障碍的创伤患者中使用苯巴比妥类药物方案可显著降低 AWS 发生率和 AWS 相关的无并发症 AWS 的发生率。
