住院照會情境下酒精戒斷之評估與處置

Evaluation and Management of Alcohol Withdrawal in the Inpatient Consultation Setting

在進入醫療體系接受治療的病患中，適當照護不當之酒精使用、酒精戒斷與其併發症是臨床團隊一直以來很大的挑戰，也是精神科照會聯商醫學中常會需要面對的課題。因為病患屬性和一般內外科病人有一定的差異性與特殊性，精神科照會醫師在熟知酒精戒斷的處理方針以外，尚需對各種急慢性身體疾患有一定的認識，並根據不同的醫療情境（門診、一般病房、加護病房，甚至監所）調整處置建議。本文將以2020年The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management為骨幹，並聚焦在臨床情境，介紹照會聯商精神科醫師在面對可能為酒精戒斷病患之照會時。應如何參考實證基礎快速執行篩檢、進行風險評估，並提供原診治團隊明快。且符合臨床需求的治療建議。

Providing adequate care for hospitalized patients with issues of problematic alcohol use, alcohol withdrawal and its complications has long been a challenge for medical teams, and are one of the most prevalent requests present for consultation-liaison psychiatrists. Due to the special characteristics compared to common hospitalized patients, consultation-liaison psychiatrists need not only to be familiar with the general management of alcohol withdrawal, but also must acquaint themselves to the many medical or surgical illnesses that may befall the patient, and the complications that may arise during standard alcohol withdrawal management. Consultation-liaison psychiatrists are also expected to provide advice of management according to the different treatment environment (outpatient departments, general wards, intensive care units, or even incarceration facilities) available to the patient and the facility. This review combines the treatment recommendations from the 2020 ASAM Clinical Practice Guideline on Alcohol Withdrawal Management and evidence based on clinical experience, with aims to provide guidance to consultation-liaison psychiatrists on consultations concerning patients with potential risk for alcohol withdrawal. This review also provides evidence-based recommendations in order to efficiently screen, provide risk stratification and convey treatment advice to primary medical teams on this special group of patients.