於精神科病房使用固定劑量及症狀導向療法處理酒精解毒之差異

Comparison between Fixed-dosed Therapy and Symptom-triggered Therapy for Alcohol Detoxifi cation in a Psychiatric Setting

背景：目前最常使用症狀導向或固定劑量的方式治療酒精戒斷症狀。本研究是在精神科 病房中，比較使用症狀導向及固定劑量處理酒精戒斷症狀的療效及差異。 方法：利用病歷回 顧的方式，分析 60 位診斷符合 DSM-IV-TR 酒精依賴的病人（30 位使用症狀導向治療、30 位使用固定劑量治療）。比較兩組病人酒精戒斷症狀的改善程度及 benzodiazepine 的使用劑 量。本研究以酒精戒斷臨床量表中文版 (CIWA-Ar-C) 評估並追蹤住院期間病人的酒精戒斷嚴 重度。 結果：雖然使用症狀導向療法的病人在入院首日之平均酒精戒斷症狀較固定劑量療法 的病人嚴重 (CIWA-Ar-C 15.2 vs. 9.4, p < 0.001)，但治療兩天後後兩組酒精戒斷嚴重度便呈現 沒有差異。接受症狀導向療法的病人比固定劑量療法者使用顯著較少的 benzodiazepine（前 三日用量：10.3 ± 4.5 vs. 23.1 ± 9.0 毫克；一週用量：18.0 ± 6.9 vs. 47 ± 18.8 毫克，p < 0.001）。 結論：相同於以往文獻中有關內科單位治療酒精戒斷症狀的結果，我們的研究顯 示在精神科病房中，比較症狀導向療法與固定劑量療法，二者處理酒精戒斷症狀療效相當， 但前者所開立的 benzodiazepine 總藥量顯著減少。

Objective:Benzodiazepine is the drug of choice in treating alcohol with-drawal syndrome (AWS). Fixed-dosed therapy (FDT) and Symptom-triggered therapy (STT) are the commonly used treatment strategies. In this study, we in-tended to assess the benefits of the newly introduced STT compared to FDT for AWS management in a psychiatric setting. Methods:We retrospectively reviewed the medical records of 60 admitted patients fulfilling DSM-IV-TR criteria for alco-hol dependence. They were divided into two groups based on the alcohol detoxifi-cation regimen they received (30 patients each in STT and FDT). AWS severity was measured using a Chinese version of the revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar-C). We also compared the total loraze-pam dosages and the changes in CIWA-Ar-C scores. Results:We found that de-spite the first-day AWS severity being more severe in the STT group (CIWA-Ar-C 15.2 vs. 9.4, p < 0.001), patients in the STT group received significantly less loraz-epam dosage compared to the FDT group during detoxification (10.3 ± 4.5 vs. 23.1 ± 9.0 mg for Day 1-3; 18.0 ± 6.9 vs. 47 ± 18.8 mg for Day 1-7, p < 0.001). Conclusion:Being consistent with previous reports that supported the advantage of STT in medical wards when managing AWS, our study provides evidence that STT is as effective as FDT for alcohol detoxification in psychiatric settings and associated with less doses of lorazepam.