Erstad B L, Cotugno C L
Department of Pharmacy Practice, College of Pharmacy, University of Arizona, Tucson 85721, USA.
Am J Health Syst Pharm. 1995 Apr 1;52(7):697-709. doi: 10.1093/ajhp/52.7.697.
The diagnosis, evaluation and assessment, supportive care, and pharmacologic treatment of acute alcohol withdrawal are reviewed. Patients in alcohol withdrawal have decreased or stopped their heavy, prolonged ingestion of alcohol and have subsequently begun to have at least two of the following symptoms: autonomic hyperactivity, tremor, nausea or vomiting, hallucinations, psychomotor agitation, anxiety, and grand mal seizures. Evaluation of the patient at risk for alcohol withdrawal should include a complete history and physical examination; laboratory tests are often indicated. The patient's progress should be assessed before, during, and after therapy, preferably with a validated instrument. After the initial evaluation and assessment but before the administration of dextrose-containing solutions, a 100-mg dose of thiamine hydrochloride should be given by i.m. or i.v. injection. Routine supplementation with calcium, magnesium, and phosphate is questionable. The need for fluid and electrolyte administration varies depending on losses. Most patients in alcohol withdrawal can be managed with supportive care alone, but for more severe or complicated withdrawal, pharmacologic therapy may be necessary. Benzodiazepines, especially diazepam and chlordiazepoxide, are the drugs of choice. Barbiturates, beta-blockers, and antipsychotics are generally not recommended as first-line therapy. Several drugs in other classes, including carbamazepine and clonidine, have been shown to be about as effective as benzodiazepines in a few studies, but the studies were small, the patients were usually in mild withdrawal, and validated instruments for assessing withdrawal were often not used. Some agents, such as beta-blockers, may play a role as adjuncts to, not replacements for, benzodiazepine therapy. For patients in alcohol withdrawal who do not respond to supportive care, benzodiazepines are the treatment of choice.
本文综述了急性酒精戒断的诊断、评估、支持治疗及药物治疗。酒精戒断患者减少或停止了大量、长期饮酒，随后开始出现以下至少两种症状：自主神经功能亢进、震颤、恶心或呕吐、幻觉、精神运动性激越、焦虑及癫痫大发作。对有酒精戒断风险的患者进行评估应包括完整的病史和体格检查；通常还需进行实验室检查。应在治疗前、治疗期间及治疗后对患者的病情进展进行评估，最好使用经过验证的工具。在进行初始评估和评估后但在给予含葡萄糖溶液之前，应通过肌内或静脉注射给予100毫克盐酸硫胺。常规补充钙、镁和磷酸盐是否必要尚存在疑问。液体和电解质的补充需求因丢失情况而异。大多数酒精戒断患者仅通过支持治疗即可处理，但对于更严重或复杂的戒断情况，可能需要药物治疗。苯二氮䓬类药物，尤其是地西泮和氯氮䓬，是首选药物。巴比妥类药物、β受体阻滞剂和抗精神病药物一般不推荐作为一线治疗药物。在一些研究中，其他类别的几种药物，包括卡马西平和可乐定，已显示出与苯二氮䓬类药物效果相当，但这些研究规模较小，患者通常处于轻度戒断状态，且往往未使用经过验证的评估戒断的工具。一些药物，如β受体阻滞剂，可能作为苯二氮䓬类药物治疗的辅助药物，而非替代药物。对于对支持治疗无反应的酒精戒断患者，苯二氮䓬类药物是首选治疗方法。
