Fiore Marco, Alfieri Aniello, Torretta Giacomo, Passavanti Maria Beatrice, Sansone Pasquale, Pota Vincenzo, Simeon Vittorio, Chiodini Paolo, Corrente Antonio, Pace Maria Caterina
Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via Luigi De Crecchio, 2, 80138 Naples, Italy.
Department of Anesthesiology and Reanimation, "San Giuseppe Moscati" Hospital, 83100 Avellino, Italy.
Pharmaceuticals (Basel). 2024 Aug 26;17(9):1125. doi: 10.3390/ph17091125.
Alcohol withdrawal syndrome (AWS) is defined as the cessation or reduction in heavy and prolonged alcohol use within several hours to a few days of cessation. The recommended first-line therapy for AWS ranging from mild to severe or complicated remains benzodiazepines; in cases where benzodiazepines are not adequate in controlling persistent autonomic hyperactivity or anxiety, dexmedetomidine could be utilized. The possible advantage of dexmedetomidine compared to benzodiazepines is that it does not cause respiratory depression, thus reducing the risk of intubation and hospitalization in the ICUs, with the potential reduction in healthcare costs. The purpose of this systematic review and meta-analysis (PROSPERO CRD42018084370) is to evaluate the effectiveness and safety of dexmedetomidine as adjunctive therapy to the standard of care for the treatment of AWS. We retrieved literature from PubMed, EMBASE, and CENTRAL until 10 January 2024. Eligible studies were both randomized trials and nonrandomised studies with a control group, published in the English language and peer-reviewed journals. The primary outcome was tracheal intubation; secondary outcomes were (i) bradycardia and (ii) hypotension. A total of 3585 papers were retrieved: 2635 from EMBASE, 930 from Medline, and 20 from CENTRAL. After eliminating duplicates, 2960 papers were screened by title and abstract; 75 out of the 2960 papers were read in full text. The qualitative synthesis included nine of all manuscripts read in full text. The quantitative synthesis included eight studies for the primary outcome (tracheal intubation), seven for the secondary outcome bradycardia, and six for the secondary outcome hypotension. The meta-analysis showed that Dexmedetomidine, as adjunctive therapy, is not more effective than standard therapy in reducing the risk of tracheal intubation in AWS [RR: 0.57, 95% CI: 0.25-1.3, = 0.15]. It also appears to be less safe than sedative therapy as it significantly increases the risk of bradycardia [RR: 2.68, 95% CI: 1.79-4.16, = 0.0016]. Hypotension was not significantly different in patients who received dexmedetomidine [RR: 1.5, 95% CI: 0.69-3.49, = 0.21].
酒精戒断综合征（AWS）的定义是在停止大量且长期饮酒后的数小时至数天内，饮酒量减少或停止饮酒。对于轻度至重度或复杂的AWS，推荐的一线治疗药物仍然是苯二氮䓬类药物；在苯二氮䓬类药物不足以控制持续性自主神经功能亢进或焦虑的情况下，可以使用右美托咪定。与苯二氮䓬类药物相比，右美托咪定的可能优势在于它不会引起呼吸抑制，从而降低了在重症监护病房插管和住院的风险，有可能降低医疗成本。本系统评价和荟萃分析（PROSPERO CRD42018084370）的目的是评估右美托咪定作为辅助治疗手段，用于治疗AWS的标准治疗方案时的有效性和安全性。我们从PubMed、EMBASE和CENTRAL数据库中检索截至2024年1月10日的文献。符合条件的研究包括随机试验和有对照组的非随机研究，发表于英文且经过同行评审的期刊。主要结局是气管插管；次要结局是（i）心动过缓和（ii）低血压。共检索到3585篇论文：2635篇来自EMBASE，930篇来自Medline，20篇来自CENTRAL。在剔除重复项后，通过标题和摘要筛选出2960篇论文；在这2960篇论文中，75篇进行了全文阅读。定性综合分析纳入了所有全文阅读的手稿中的9篇。定量综合分析纳入了8项关于主要结局（气管插管）的研究、7项关于次要结局心动过缓的研究以及6项关于次要结局低血压的研究。荟萃分析表明，作为辅助治疗手段，右美托咪定在降低AWS患者气管插管风险方面并不比标准治疗更有效[风险比（RR）：0.57，95%置信区间（CI）：0.25 - 1.3，P = 0.15]。而且，它似乎比镇静治疗更不安全，因为它显著增加了心动过缓的风险[RR：2.68，95% CI：1.79 - 4.16，P = 0.0016]。接受右美托咪定治疗的患者低血压情况无显著差异[RR：1.5，95% CI：0.69 - 3.49，P = 0.21]。
