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酒精性肝病患者酒精戒断综合征的管理

Management of Alcohol Withdrawal Syndrome in Patients with Alcoholic Liver Disease.

作者信息

Chand Prabhat Kumar, Panda Udit, Mahadevan Jayant, Murthy Pratima

机构信息

Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.

Kalinga Institute of Medical Sciences, Bhubaneshwar, India.

出版信息

J Clin Exp Hepatol. 2022 Nov-Dec;12(6):1527-1534. doi: 10.1016/j.jceh.2022.03.003. Epub 2022 Mar 18.

Abstract

Alcohol withdrawal syndrome (AWS) is a common condition that is seen in treatment-seeking patients with Alcohol use disorder (AUD) and alcoholic liver disease (ALD). AWS, which typically starts within 4-6 h of the last alcohol use, can range from mild symptoms such as insomnia, tremors, and autonomic hyperactivity to more severe symptoms such as seizures and delirium tremens. Clinical Institute Withdrawal Assessment Scale-Alcohol Revised (CIWA-Ar) is the most commonly used scale to assess AWS in clinical practice. The presence of moderate withdrawal as indicated by a score of more than 8 is an indication for pharmacotherapy. Lorazepam and oxazepam are preferred agents for the management of AWS in the setting of ALD. In severe ALD, benzodiazepines should be used cautiously with monitoring due to the risk of excessive sedation or precipitating hepatic encephalopathy.

摘要

酒精戒断综合征(AWS)是一种常见病症,在寻求治疗的酒精使用障碍(AUD)和酒精性肝病(ALD)患者中可见。AWS通常在最后一次饮酒后4 - 6小时内开始,症状范围从轻微症状如失眠、震颤和自主神经功能亢进到更严重的症状如癫痫发作和震颤谵妄。临床研究所酒精戒断评估量表修订版(CIWA - Ar)是临床实践中评估AWS最常用的量表。评分超过8分表明存在中度戒断,这是药物治疗的指征。在ALD情况下,劳拉西泮和奥沙西泮是治疗AWS的首选药物。在严重的ALD中,由于存在过度镇静或诱发肝性脑病的风险,使用苯二氮䓬类药物时应谨慎并进行监测。

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