Saitz R, Friedman L S, Mayo-Smith M F
Section of General Internal Medicine, Boston City Hospital, Massachusetts 02118, USA.
J Gen Intern Med. 1995 Sep;10(9):479-87. doi: 10.1007/BF02602395.
To describe current practices employed in the inpatient treatment for alcohol withdrawal.
Survey.
Inpatient alcoholism treatment programs in the United States.
Medical directors of 176 (69%) of 257 eligible programs randomly selected from a national listing.
The medical directors estimated that of all inpatients treated for alcohol withdrawal at the programs, 68% received one of the following medications. Benzodiazepines, including the long-acting chlordiazepoxide (33%) and diazepam (16%), and less frequently the short-acting oxazepam (7%) and lorazepam (4%), were the most commonly used agents. Barbiturates (11%), phenytoin (10%), clonidine (7%), beta-blockers (3%), carbamazepine (1%), and antipsychotics (1%) were less frequently given. Drug was most often given on a fixed dosing schedule with additional medication "as needed" (52% of the programs). Only 31% of the programs routinely used a standardized withdrawal severity scale to monitor patients. Mean duration of sedative treatment was three days; inpatient treatment, four days. Use of fixed-schedule regimens was associated with longer sedative treatment (mean four vs three days, p < 0.01). Northeast census region location and psychiatrist program director were significantly associated with longer sedative and inpatient treatment duration.
The most commonly reported regimen for alcohol withdrawal included three days of long-acting benzodiazepines on a fixed schedule with additional medication "as needed." Standardized monitoring of the severity of withdrawal was not common practice. The directors reported using a variety of other regimens, some not known to prevent the major complications of withdrawal. Although geographic location and director specialty were significantly associated with treatment duration, much of the variation in treatment for alcohol withdrawal remains unexplained.
描述目前住院治疗酒精戒断的方法。
调查。
美国住院酒精中毒治疗项目。
从全国名单中随机选取的257个符合条件项目中的176个（69%）的医疗主任。
医疗主任估计，在这些项目中接受酒精戒断治疗的所有住院患者中，68%接受了以下药物之一。苯二氮卓类药物是最常用的药物，包括长效的氯氮卓（33%）和地西泮（16%），较少使用的短效奥沙西泮（7%）和劳拉西泮（4%）。巴比妥类药物（11%）、苯妥英（10%）、可乐定（7%）、β受体阻滞剂（3%）、卡马西平（1%）和抗精神病药物（1%）使用较少。药物最常按固定剂量给药，并根据需要额外用药（52%的项目）。只有31%的项目常规使用标准化的戒断严重程度量表来监测患者。镇静治疗的平均持续时间为三天；住院治疗为四天。使用固定疗程与更长的镇静治疗时间相关（平均四天对三天，p<0.01）。东北地区人口普查区域位置和精神科项目主任与更长的镇静和住院治疗时间显著相关。
最常报告的酒精戒断治疗方案包括按固定时间表使用三天长效苯二氮卓类药物，并根据需要额外用药。对戒断严重程度进行标准化监测并不常见。主任们报告使用了各种其他方案，其中一些方案并不为人所知能否预防戒断的主要并发症。尽管地理位置和主任专业与治疗时间显著相关，但酒精戒断治疗的许多差异仍无法解释。
