Identification of risky alcohol consumption in the preoperative assessment: opportunity to diagnose and intervene.
Identification of risky alcohol consumption in the preoperative assessment: opportunity to diagnose and intervene.
复制标题
术前评估中识别危险饮酒：诊断和干预的机会。
DOI：
10.1097/aln.0b013e31817f587a
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发表时间：
2008
期刊：
影响因子：
8.8
通讯作者：
Burnham,EllenL
中科院分区：
文献类型：
--
作者：
Burnham,EllenL
酒精滥用和依赖是对全球健康产生重大影响的重要合并症，占世界总疾病负担的1.4%（世界卫生组织，2003年）。酒精滥用是一种独特的精神疾病诊断和统计手册（第四版），诊断为涉及健康、关系和法律系统的重复酒精相关后果模式，没有成瘾的证据。与此相反，酒精依赖者不仅会经历同样的后果，而且还会表现出成瘾的迹象，包括戒断症状、渴望和对酒精的专注。最近在美国进行的一项大型流行病学研究确定，酒精使用障碍（AUDs）的患病率，包括酒精滥用和依赖，为8.26%，而在欧洲，患病率甚至更高（世界卫生组织，2004年）。根据这些数据，麻醉师术前遇到AUD患者的可能性是确定的。在本期的《麻醉学》中，Kip等人提供了如何在时间短、资源有限的情况下术前识别这些个体的见解。他们的发现应该促使对术前就诊的标准操作程序进行重新评估和潜在的彻底改革。通过在术前使用计算机进行简短的问卷调查，这些研究人员证明，与麻醉师的标准术前评估相比，符合AUD标准的患者的识别率要高得多。酒精使用障碍鉴定测试（AUDIT）既嵌入在电脑问卷中，也可供临床麻醉师使用。这是一项包含10个问题的调查，旨在识别当前不健康的饮酒习惯，包括数量、频率、狂欢行为以及酒精依赖症状等问题，并已在各种临床环境中得到验证。4尽管与《精神障碍诊断与统计手册》对酒精滥用或依赖的诊断不完全相同，但根据受试者的性别、临床状况和人群中酒精滥用的流行程度，审计对aud检测的敏感性为63%至90%，特异性为79%至97%。
ALCOHOL abuse and dependence are important comorbidities that have a major impact on global health, accounting for up to 1.4% of the world’s total disease burden (World Health Organization, 2003). Alcohol abuse is a distinct Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, diagnosis with a pattern of repeated alcohol-related consequences involving health, relationships, and the legal system, without evidence of addiction. In contrast to this, alcohol-dependent individuals not only experience these same consequences, but also show signs of addiction, including withdrawal symptoms, craving, and preoccupation with alcohol. A recent large epidemiologic study in the United States determined the prevalence of alcohol use disorders (AUDs), including alcohol abuse and dependence, to be 8.26%, 1 whereas in Europe, the prevalence is even greater (World Health Organization, 2004). 2 Given these data, the likelihood for anesthesiologists to encounter a patient preoperatively with an AUD is assured. In this issue of Anesthesiology, Kip et al. 3 provide insight into how to identify such individuals preoperatively where time is short and resources are limited. Their findings should prompt a reevaluation and potential overhaul of standard operating procedures for preoperative visits.Using a brief questionnaire administered by computer in the preoperative setting, these investigators demonstrated that patients who met criteria for an AUD could be identified at a significantly greater rate than what could be determined in an anesthesiologist’s standard preoperative assessment. The Alcohol Use Disorders Identification Test (AUDIT) was both embedded in the computer questionnaire and available to the anesthesiologists in the clinic. It is a 10-question survey developed to identify current unhealthy drinking habits that includes questions about quantity, frequency, and binge behavior, as well as symptoms of alcohol dependence, and has been validated in a variety of clinical settings. 4 Although not precisely the same as a Diagnostic and Statistical Manual of Mental Disorders diagnosis of alcohol abuse or dependence, the sensitivity of the AUDIT for the detection of AUDs ranges from 63% to 90%, with a specificity of 79% to 97%, depending on the subject’s sex and clinical status, and the prevalence of alcohol abuse in the population.