DiPaula B, Tommasello A, Solounias B, McDuff D
Walter P. Carter Center, Department of Pharmacy Services, Baltimore, MD, USA.
J Subst Abuse Treat. 1998 Sep-Oct;15(5):437-42. doi: 10.1016/s0740-5472(97)00311-5.
Alcohol withdrawal is a serious complication of heavy alcohol use and a condition requiring patient stabilization before initiating surgery or implementing lifesaving procedures for injury. Intravenous ethanol (IVE) is used to prevent withdrawal during these maneuvers. This report explores the use and potential problems of this practice in an academic urban medical center. This study was undertaken to improve the treatment of IVE recipients in an urban, academic health system providing trauma, surgery, and general inpatient services. All 68 patients, identified by a review of the pharmacy database for the period August 1993 through January 1994, received IVE during their stay. A priori outcome measures related to the course of therapy in the selected cases. Of all patients studied, 67.6% were admitted for alcohol-related trauma; 61.8% of IVE recipients had no documented risk factors for delirium tremens (59.5% of these were oriented); 17.6% were discharged on the same day the drip was discontinued; only 17.6% were referred to the alcohol consult team; and, throughout the course of therapy in all cases, no blood alcohol level (BAL) determinations were recorded in patients' records. The use of IVE is associated with potentially serious clinical concerns. We found a high prevalence of alcohol-related admissions, inconsistent IVE administration, and a low rate of alcohol consult requests. Guidelines to improve the selection, management, and disposition of IVE recipients are suggested.
酒精戒断是重度饮酒的一种严重并发症，是一种在启动手术或实施创伤救生程序前需要使患者病情稳定的状况。静脉注射乙醇（IVE）用于在这些操作过程中预防戒断反应。本报告探讨了在一家城市学术医疗中心这种做法的使用情况及潜在问题。本研究旨在改善在一个提供创伤、外科和普通住院服务的城市学术医疗系统中接受IVE治疗患者的治疗效果。通过查阅1993年8月至1994年1月期间的药房数据库确定的所有68例患者在住院期间均接受了IVE治疗。在所选病例中，先验性的结果指标与治疗过程相关。在所有研究患者中，67.6%因酒精相关创伤入院；61.8%的IVE接受者没有谵妄震颤的记录风险因素（其中59.5%神志清醒）；17.6%在停止滴注当天出院；只有17.6%被转介至酒精咨询团队；而且，在所有病例的治疗过程中，患者记录中均未记录血液酒精水平（BAL）测定结果。IVE的使用存在一些潜在的严重临床问题。我们发现酒精相关入院率很高、IVE给药不一致且酒精咨询请求率很低。建议制定指南以改善IVE接受者的选择、管理和处置。
