알코올의존 환자에서 진전섬망의 발생과 관련된 임상 요인
Clinical Factors Correlated to Delirium Tremens during Acute Alcohol Withdrawal of Inpatients with Alcohol Dependence
0
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
본 연구에서는 알코올의존 환자를 대상으로 전향적인 관찰을 통해서 진전섬망의 발생과 관련이 있는 임상 요인을 알아보았다. 알코올의존으로 진단받은 164명의 환자에서 진전섬망이 발생한 42명과 진전섬망이 발생하지 않은 122명을비교한 결과 진전섬망의 과거력 및 진전, 구역 및 구토 등의알코올금단증상, 그리고 혈청 homocysteine 농도 등이 진전섬망의 발생과 관련이 있는 인자로 분석되었다. 이들 중 입원일에 금단증상의 심각도 및 진전섬망의 과거력은 알코올의존 환자에서 해독치료를 시작하면서 쉽게 평가할 수 있는임상 요인으로 해독치료 진전섬망의 발생을 미리 예측하고예방하는데 유용할 것이다.
Abstract
Objectives The aim of this study was to explore clinical factors or high-risk factors associated with occurrence of delirium tremens (DT) during acute alcohol withdrawal in inpatients with alcohol dependence. Methods This study included 164 inpatients seeking treatment for acute alcohol withdrawal in the detoxification unit. All subjects were evaluated prospectively for known risk factors for DT and their occurrence of DT. Correlations were determined between risk factors obtained at admission and development of DT. Results Among all subjects, 42 patients (25.6%) suffered from delirium tremens within seven days after admission. DT patients had more severe alcohol withdrawal symptoms, the presence of past DT, and higher levels of aspartate aminotransferas, alanine aminotransferase, gamma-glutamyl-transpeptidase, and homocysteine, compared with patients who did not suffer DTs. According to results of a multiple regression, occurrence of DT showed correlation with the following factors at admission: tremor, a past history of DT, higher homocysteine level, and nausea and vomiting. Conclusion Development of DT showed correlation with symptoms of severe alcohol withdrawal, past history of DT, and higher homocysteine level. Among these, a severity of alcohol withdrawal symptoms and a history of DT are factors that can be easily evaluated on the day of admission in order to predict the potential for occurrence of DT.
참고문헌 (19)
- Griffin RE, "Delirium tremens: a review", J Am Osteopath Assoc, 93, pp.924~935 (1993)
- Schuckit MA, "The histories of withdrawal convulsions and delirium tremens in 1648 alcohol dependent subjects", Addiction, 90, pp.1335~1347 (1995)
- Ferguson JA, "Risk factors for delirium tremens development", J Gen Intern Med, 11, pp.410~414 (1996)
- Wojnar M, "The role of somatic disorders and physical injury in the development and course of alcohol withdrawal delirium", Alcohol Clin Exp Res, 23, pp.209~213 (1999)
- Palmstierna T, "A model for predicting alcohol withdrawal delirium", Psychiatr Serv, 52, pp.820~823 (2001)
- Monte R, "Risk factors for delirium tremens in patients with alcohol withdrawal syndrome in a hospital setting", Eur J Intern Med, 20, pp.690~694 (2009)
- Lutz UC, "Alterations in homocysteine metabolism among alcohol dependent patients--clinical, pathobiochemical and genetic aspects", Curr Drug Abuse Rev, 1, pp.47~55 (2008)
- 김민정, "A Study of the Reliability and Validity of the Korean Version of the Penn Alcohol Craving Scale for Alcohol-Dependent Patients", PSYCHIATRY INVESTIGATION, 5(3), pp.175~178 (2008), 대한신경정신의학회
- Sellers EM, "Characterization of DSM-III-R criteria for uncomplicated alcohol withdrawal provides an empirical basis for DSM-IV", Arch Gen Psychiatry, 48, pp.442~447 (1991)
- Fiellin DA, "Risk for delirium tremens in patients with alcohol withdrawal syndrome", Subst Abus, 23, pp.83~94 (2002)
- 이충헌, "알코올 금단 섬망 발생의 예측", 신경정신의학, 43(5), pp.559~563 (2004), 대한신경정신의학회
- Lee JH, "Clinical predictors for delirium tremens in alcohol dependence", J Gastroenterol Hepatol, 20, pp.1833~1837 (2005)
- Rommelspacher H, "Pathobiochemistry and pharmacotherapy of alcohol withdrawal delirium", Nervenarzt, 62, pp.649~657 (1991)
- 김원기, "Neurotoxicity associated with dual actions of homocysteine at the N-methyl-D-aspartate receptor", PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA, 94, pp.5923~5928, NATL ACAD SCIENCES
- Bleich S, "Homocysteine levels in patients classified according to Lesch’s typology", Alcohol Alcohol, 39, pp.493~498 (2004)
- Wetterling T, "Clinical predictors of alcohol withdrawal delirium", Alcohol Clin Exp Res, 18, pp.1100~1102 (1994)
- Hersh D, "Persistent delirium following cessation of heavy alcohol consumption: diagnostic and treatment implications", Am J Psychiatry, 154, pp.846~851 (1997)
- Kraemer KL, "Independent clinical correlates of severe alcohol withdrawal", Subst Abus, 24, pp.197~209 (2003)
- Wetterling T, "The severity of alcohol withdrawal is not age dependent", Alcohol Alcohol, 36, pp.75~78 (2001)