Milzman D P, Soderstrom C A
Department of Emergency Medicine, Georgetown University Medical Center, Washington, DC.
Crit Care Clin. 1994 Jul;10(3):595-612.
The consequences of acute and chronic drug abuse pose significant problems for physicians managing the trauma victim in the resuscitative, perioperative, intensive care, and hospitalization periods. Substance abuse, whether acute or chronic, modifies the physiologic response to injury and to resuscitative and operative measures. Trauma and critical care physicians must have insight into ways to improve the detection, resuscitation, and management of trauma patients with acute substance intoxication or chronic abuse history. The need for prophylaxis of withdrawal syndrome differs with drug type. The major difficulty is proper identification of individuals at risk, which is complicated by patients' unconsciousness, reluctance, or medical inability to give detailed history of substance use. Failure to recognize withdrawal symptoms may both confuse the diagnosis of traumatic injury and be life-threatening. The goal in treating the trauma patient who is also a substance abuser is both to fully assess that person's injuries and achieve physiologic stability and use the hospitalization as an opportunity to educate and counsel the patient to abandon his or her destructive behavior.
急性和慢性药物滥用的后果给在复苏、围手术期、重症监护及住院期间治疗创伤患者的医生带来了重大问题。药物滥用，无论是急性还是慢性，都会改变机体对损伤以及复苏和手术措施的生理反应。创伤和重症监护医生必须深入了解如何改进对有急性药物中毒或慢性药物滥用史的创伤患者的检测、复苏及管理方法。预防戒断综合征的需求因药物类型而异。主要困难在于正确识别有风险的个体，而患者无意识、不愿或因身体原因无法提供详细用药史使情况变得复杂。未能识别戒断症状可能会混淆创伤性损伤的诊断，且会危及生命。治疗同时也是药物滥用者的创伤患者的目标，是全面评估该患者的损伤情况并实现生理稳定，同时利用住院机会对患者进行教育和劝导，使其摒弃有害行为。
