EPOCH-MAKING THERAPY IN PROLONGED ALCOHOL WITHDRAWAL SYNDROME

在我们的初步研究中，急性酒精导致哺乳动物运动活动和体温的昼夜节律发生相移，而慢性酒精治疗导致哺乳动物自由奔跑节律的周期发生变化。这些数据表明，长期饮酒可能会导致人体昼夜节律紊乱，如失眠、继发性抑郁、酒精戒断和酒精中毒后长时间戒酒。在这项研究中，我们调查了150例住院酒精中毒患者中81例(54%)曾被诊断为酒精戒断(震颤性妄想)，其中11例(13.6%)被诊断为长期戒酒(震颤性妄想)。研究了特异性苯二氮卓类拮抗剂氟马西尼治疗肝性昏迷和陈旧性震颤昏迷的临床疗效。方法：1)根据肝昏迷程度判断肝昏迷程度，用CIWA量表评定戒酒情况，并在注射氟马西尼前后进行脑电检查。氟马西尼静脉滴注，持续24小时静脉滴注，连用数天。结果，所有昏迷的患者在几分钟内明显逆转，脑电恢复到枕部阿尔法优势活动的正常范围，此后继续保持正常范围。此外，这可能为阐明酒精戒断过程中可能存在苯二氮卓类受体异常或可能存在反向激动剂配体的理论提供线索。我们的结论是，这项临床研究可能对发现一种新的治疗长期酒精戒断(延长颤颤性精神错乱)和防止过渡到与酒精相关的痴呆症非常重要。

In our preliminary study, acute alcohol produced phase-shifts in the circadian rhythms of locomotor activity and body temperature, while chronic alcohol treatment induced changes in the periods of free-running rhythms in mammals. These data suggest that chronic administration of alcohol may cause disordered circadian rhythms in humans, for example, insomnia, secondary depression, alcohol withdrawal and prolonged alcohol withdrawal in alcoholism. In this study, we investigated that 81 (54%) of 150 inpatients with alcoholism had been treated under a diagnosis of alcohol withdrawal (delirium tremens) and 11 of these 81 cases (13.6%) had been diagnosed with prolonged alcohol withdrawal (prolonged delirium tremens). The clinical efficacy of specific benzodiazepine antagonist flumazenil for hepatic coma and prolonged delirium tremens was studied. Methods were as follows : 1) The level of hepatic coma was assessed by the stage of hepatic coma, alcohol withdrawal was assessed with CIWA and each subject was examined byelectroencephalogram(EEG) before and after flumazenil injection. Flumazenil was given as an iv infusion and continuously given as an 24-hr iv drip injection for a few days. As a result, all unconscious patients were clearly reversed in a few minutes, and EEG returned to normal ranges of alpha dominant activities at occipital sites and normal ranges persisted thereafter. Additionally, this may provide a clue to elucidating the theory that there may be abnormalities of the benzodiazepine receptor, or a possible inverse agonist ligand in alcohol withdrawal. We conclude that this clinical study may be very important to discovering a new therapy for prolonged alcohol withdrawal (prolonged delirium tremens) and for preventing transition to dementia associated with alcohol.