乙醇中毒性精神障碍82例临床护理体会

<正>随着经济的发展,社会压力的不断增大,乙醇滥用和依赖已成为当今世界重大社会问题和医学问题,随之而来,乙醇中毒性疾病亦呈现逐年增多趋势,我院2001年6月~2011年5月间,共收治82例乙醇中毒所致精神障碍患者,经过治疗和精心护理均取得了满意的疗效,现报告如下。     

慢性乙醇中毒性肌病5例临床分析

0 引言 慢性乙醇中毒性肌病(chronic alcoholic myopathy,CAM)是由于长期酗酒引起的一种肌病.乙醇依赖和乙醇中毒性疾病患者有逐年增多的趋势,对乙醇中毒性肝病、脑病和周围神经病已有较多研究[1],但对乙醇中毒性肌病少有报道,现将我院2002-05/200608收治的5例患者分析如下.     

急性乙醇中毒大鼠大脑皮层氨基酸类递质的变化及吡拉西坦的干预研究

目的观察急性乙醇中毒大鼠大脑皮层谷氨酸（glutamic acid,Glu）、γ-氨基丁酸（gamma aminobutyric acid,GABA）含量的变化以及吡拉西坦的干预作用。方法选雄性Wistar大鼠30只,随机分为对照组、模型组、吡拉西坦组,采用高效液相色谱-紫外法测定各组大脑皮层谷氨酸和γ-氨基丁酸含量的变化。结果与对照组相比,模型组大鼠大脑皮层谷氨酸和γ-氨基丁酸水平显著降低,谷氨酸与γ-氨基丁酸的比值显著升高。吡拉西坦组与模型组相比,谷氨酸和γ-氨基丁酸水平均显著升高,谷氨酸与γ-氨基丁酸的比值有所降低但变化不明显。结论急性乙醇中毒时脑内氨基酸类递质有一定的变化,吡拉西坦可在一定程度上降低酒精的损害作用。     

CYP2E1在乙醇性肝病发病机制中的作用

<正>乙醇滥用一直是全球范围内重要的公共健康问题。长期大量饮酒可引发乙醇性肝病(ALD),包括乙醇性脂肪肝、乙醇性肝炎、乙醇性肝硬化。重度饮酒者中80%以上有一定程度的脂肪肝,其中10%～35%可发展为乙醇性肝炎,10%～20%可发展为肝硬化。从以往情况来看,欧美等国的发病率远远高于我国。在英、美等国,8%～14%的人群乙醇依赖或乙醇中毒,1/3的嗜酒者发展成为ALD。近年来,随着国内乙醇生产和消费量的迅速上升,我国ALD的发     

乙醇对蟾蜍神经-肌接头传递的影响

目的　研究乙醇对神经肌肉接头 (NMJ)兴奋传递的影响及可能机制。方法　用微电极细胞内记录的方法 ,在 2 0只成年蟾蜍的坐骨神经 -缝匠肌标本上研究乙醇对终板电位 (EPP)和微小终板电位 (MEPP)的影响。结果　乙醇可引起 EPP振幅改变 ,影响 NMJ的兴奋传递 ,而且其影响具有明显的量效依赖关系 ,适当浓度的乙醇能明显地增加 EPP振幅 ,促进 NMJ的兴奋传递。乙醇还可使 MEPP的频率增加 ,但对 MEPP的振幅无影响。结论　初步确定乙醇促进 NMJ兴奋传递的部位是在突触前 ,其机制是使突触前释放的递质的量子数增加     

解毒脱瘾汤对吗啡依赖小鼠单胺类递质的影响

目的 :观察解毒脱瘾汤 (JTD)对吗啡依赖小鼠的作用机制。方法 :采用小鼠戒断模型 ,观察解毒脱瘾汤对吗啡依赖小鼠单胺类递质的影响。结果 :吗啡依赖小鼠单胺类递质明显增多 ;解毒脱瘾汤高剂量组可降低脑组织和血浆 NE、5 - HT的含量 ;几乎所有剂量组均可降低脑组织和血浆 DA的含量 ;但是 5 - HIAA变化不明显。结论 :单胺类递质在吗啡依赖模型中可能起着重要作用 ,解毒脱瘾汤可能通过改善吗啡依赖小鼠单胺类物质含量的变化 ,消除其戒断症状 ,从而达到治疗的目的     

氰化物对大鼠脑单胺类递质的影响

大鼠腹腔注射NaCN中毒后3,5、10、30、45和60min用荧光法分别测定脑内多巴胺(DA)、去甲肾上腺素(NE)、5-羟色胺(5-HT)和5-羟吲哚乙酸(5-IHAA)含量。结果表明,中毒后脑内以上4种单胺含量呈剂量依赖性下降,45min时,低剂量NaCN(2.36mg/kg)中毒动物脑内DA和NE含量显著升高。氰化物中毒惊厥时伴有脑内单胺类递质含量的显著降低。提示脑内单胺类递质的变化在氰化物中枢毒理作用中可能具有重要意义。     

乙醇对蟾蜍神经—肌接头传递的影响

目的 研究乙醇对神经肌肉接头（NMJ）兴奋传递的影响及可能机制。方法 用微电极细胞内记录的方法,在20只成年蟾蜍的坐骨神经－缝芹肌标本上研究了乙醇对终板电位（EPP）和微小终板电位（MEPP）的影响。结果 乙醇可引起EPP振幅改变,影响NMJ的兴奋传递,而且其影响具有明显的量效依赖关系,适当浓度的乙醇能明显地增加EPP振幅,促进MMJ的兴奋传递。乙醇还可使MEPP的增加,但对MEPP的振幅无影响。结论 初步确定乙醇促进NMJ兴奋传递的部位是在突触前,其机制是使 突触前释放的递质的量子数增加。     

中药柿蒂汤剂戒酒的临床对照观察

饮酒所带来的问题及酒依赖、酒中毒在发达国家比较突出,据美国schuckit等人的报告,一生中出现酒精滥用或酒依赖的比率在男性约15%在女性约5%[1].……     

纳络酮在治疗重症乙醇中毒中的观察护理

目的:分析探讨纳络酮在治疗重症乙醇中毒的观察和护理方法。方法:回顾性分析89例重症乙醇中毒患者临床资料,观察护理要点。结果:出现不同程度的昏睡或昏迷症状同时分别伴有瞳孔散大、血压下降、小便失禁、呼吸抑制等症状,给予纳洛酮静脉推注及常规内科治疗,均治愈出院。结论:纳络酮在治疗重症乙醇中毒的过程要严密观察患者生命体征,护理过程加强看护,避免窒息以及外伤的发生,便于及时采取治疗措施。     

急性乙醇中毒大鼠下丘脑阿片肽含量的变化及葛根素的干预研究

目的观察急性乙醇中毒大鼠下丘脑β-内啡肽（β—endorphine,β—EP）、亮脑啡肽（leu—enkephalin,LENK）和强啡肽A（dynorphin A,DynA）含量变化及葛根素的干预作用。方法选雄性Wistar大鼠30只,随机分为对照组、模型组和葛根素组,分别测定血中乙醇浓度变化,下丘脑β—EP,LENK,Dyn A的含量。结果葛根素组的血乙醇浓度比模型组低,与对照组相比,模型组大鼠下丘脑β-EP,LENK水平显著增高,DynA的含量变化不明显。葛根素组与模型组相比,β-EP,LENK水平均显著降低,Dyn A含量变化不明显。结论急性乙醇中毒时阿片肽释放增加,葛根素可能通过降低血乙醇浓度来抑制阿片肽的释放,对乙醇中毒起到治疗作用。     

慢性乙醇中毒大鼠脑内内源性阿片肽系统含量的改变

目的观察慢性乙醇中毒大鼠下丘脑、纹状体以及海马内源性阿片肽,即β-内啡肽（β-endorphine,β—EP）、甲硫脑啡肽（met—enkephalin,MENK）、亮脑啡肽（1eu—enkephalin,LENK）和强啡肽A（dynorphin A,Dyn A）含量的变化,并记录其血中乙醇浓度的变化,以探讨乙醇对中神经系统的损害与内源性阿片肽系统的关系。方法用成年Wistar大鼠建立慢性乙醇中毒大鼠动物模型。结果慢性乙醇中毒后大鼠下丘脑、纹状体以及海马内β-EP,LENK以及DynA含量均有不同程度的降低（P〈0．05或P〈0．01）,MENK在下丘脑和海马含量变化不大（P〉0．05）,只有纹状体内MENK的含量降低（P〈0．05）。结论慢性乙醇中毒时下丘脑、纹状体以及海马内源性阿片肽含量有不同程度的下降,这可能与乙醇奖赏效应的发生以及学习记忆障碍有关。     

慢性酒中毒性精神障碍70例临床分析

目的 为了解慢性酒中毒性精神障碍的临床特点，肝功能、ECG、EEG及头颅CT改变情况。方法 分析了慢性酒中毒性精神障碍70例的临床资料。结果 精神障碍类型中以酒依赖综合症最高，占97．14％，疗效以酒中毒性谵妄、酒中毒性幻觉症效较佳，酒依赖综合症及酒中毒性遗忘、痴呆最差。肝功化验及B超异常率分别为37．14％、28．57％；EEG、头颅CT异常率为25．71％、44．82％；ECG异常率为8．57％；11．43％性功能障碍；77．1％有不同程度的社会功能损害；复发率为20％。结论 酒精即可致精神障碍，又可致躯体损害及社会功能损害，酒精滥用问题应引起足够重视。     

Parental Alcoholism, Adverse Childhood Experiences, and Later Risk of Personal Alcohol Abuse among Chinese Medical Students

Objective To determine the status of adverse childhood experiences （ACEs） and the association of multiple ACEs with both parental alcoholism and later personal alcohol abuse among Chinese medical students with a view of improving adolescent health and reducing alcohol abuse among them. Methods In this cross-sectional study, 2073 Chinese medical students completed a survey on ten categories of ACEs in Anhui province of China. The association of parental alcoholism with ACEs and personal alcohol abuse was assessed by logistic regression analyses. Results The adjusted odds ratio （OR） for each category of ACEs in the subjects whose parents （either fathers or mothers or both） had alcohol abuse was 2 to 14 times higher than that in those with parental alcoholism （P〈0.05）. Subjects with bi-parental alcoholism had the highest likelihood of ACEs. Compared with the subjects without ACEs, therisk of personal alcohol abuse was increased by 2-4-folds in the subjects with ACEs, irrespective of parental alcoholism （P〈0.05）. The total number of ACEs （ACE score） had a graded relationship to 4 categories of personal alcohol abuse with or without parental alcoholism. The prevalence of personal alcohol abuse among the subjects with parental alcoholism was higher, which was independent of ACE scores. Conclusion The prevalence of ACEs is generally serious in China. Efforts should be made to prevent and treat children with ACEs and subsequently to reduce alcohol abuse and later problems.     

Detecting alcohol use disorders in primary care settings

Much attention is focused on individuals who abuse alcohol orare alcohol-dependent. Less attention is given to individuals whose drinking patterns should be of concern, though these individuals may not have met criteria for alcohol abuse or dependence. Alcohol use can be conceptualized as occurring on a continuum. Recognizing patterns of alcohol misuse is important to prevent individuals from consequences that can occur along the continuum. Physicians can help individuals at earlier stages in the continuum through education and firm advice to change drinking patterns. Individuals with a family history of alcoholism are at greater risk of developing alcoholism and should be identified as early in the continuum as possible. The primary care setting is an ideal place to educate and intervene regardless of where on the continuum a patient may be. A vignette is used to illustrate the process of screening, assessment, and follow-up in a primary care setting.     

Substance abuse by medical students and doctors

The doctors are vulnerable to substance abuse/addiction due to their ready accessibility to the substances of abuse. There is higher percentage use of alcohol, tranquillisers and psychedelics among medical students, and dependence rates are 5% for medical students and 3% for doctors. Majority of the substance-abusing doctors are graduates, belong to medicine speciality (21%) and majority of them prescribe drugs to themselves (37%). The consultants experience more substance related complications, despite having late age of onset of alcohol and substance dependence, less number of concomitant substance abuse and less career handicap. Stress (situational, personal and professional), medical student abuse and family history of alcoholism are the major risk factors. Despite paucity of studies in Indian population, substance use is reported between 32.5% to as high as 81.2% among medical students, intems and house physicians. In spite of the treatment dilemmas, the physicians do respond favourably to treatment. These findings have implications in planning preventive and interventional strategies for this professional group.     

Early identification of alcohol abuse: 2: Clinical and laboratory indicators

Despite awareness of the wide variety of clinical and laboratory abnormalities associated with alcohol abuse, drinking problems often remain undetected in hospital and in general medical practice. The diagnosis of alcohol abuse has been emphasized repeatedly in the literature but far less attention has been paid to indicators that would permit detection of excessive drinking at a stage when intervention might be more effective and less costly. The search for indicators of early alcohol abuse is complicated since many of the medical sequelae of alcoholism are nonspecific and may only be manifested after a number of years of excessive drinking. Part 2 of this two-part series considers various clinical and laboratory features related to alcohol abuse and highlights items that are potentially more sensitive for detecting early stages of problem drinking. Use by physicians of a composite profile of both biomedical and psychosocial indicators of excessive alcohol consumption is recommended for early identification of this problem.     

Underdiagnosis of alcoholism by residents in an ambulatory medical practice

Alcoholism is a widespread illness which in its early stages can be treated effectively. It is important, therefore, that medical residents be able to diagnose alcoholism prior to end-stage disease and organ damage. To assess the ability of residents to diagnose alcoholism, a survey was conducted of 95 patients from the ambulatory care internal medicine practice of the Johns Hopkins Hospital. The patients' alcohol consumption was measured by a self-report questionnaire, and the patients answered an alcoholism questionnaire, the responses to which have been shown to correlate with alcoholism. The questionnaire contains four questions, one each on cutting down on alcohol consumption, annoyance at criticism of alcohol consumption, guilty feelings about alcohol consumption, and use of alcohol early in the day. The answers to the questionnaire were compared with the residents' diagnoses of alcoholism on the medical record. Alcoholism was diagnosed by the residents in only 11 of the 20 patients (55 percent) who had given three or more yes answers on the alcoholism questionnaire and in only 14 of the 31 patients (45 percent) who had given two or more yes answers. (Yes answers indicate that patients suffer from alcoholism.) The residents' diagnosis of alcoholism correlated with signs of physical damage or dependence. These results demonstrate a moderate underdiagnosis of alcoholism by residents in the ambulatory care setting and suggest that diagnosing alcoholism in early stages of the disease should be made a part of the training curriculum.     

Prevalence, detection, and treatment of alcoholism in hospitalized patients

As part of an institution-wide program to enhance the education of physicians in diagnosing and treating alcohol dependence and abuse, a comprehensive survey was conducted in which all new admissions to the adult inpatient services of The Johns Hopkins Hospital were screened for alcoholism. The prevalence of screen-positive alcoholism, by department, was as follows: medicine (25%), psychiatry (30%), neurology (19%), obstetrics-gynecology (12.5%), and surgery (23%). Detection rates by the house staff and faculty physicians caring for those patients who screened positively were less than 25% in surgery and obstetrics-gynecology, between 25% and 50% in neurology and medicine, and greater than 50% in psychiatry. However, physicians were less likely to identify as alcoholic those patients with higher incomes, higher education, or private medical insurance; women; and those who denied heavy alcohol intake. Physician-instituted treatment rates for those patients diagnosed by the physician as having nonrecovered alcoholism were less than 50% in surgery and obstetrics-gynecology, between 50% and 75% in medicine and neurology, and 100% in psychiatry. The extent to which the physicians intervened while the patient was hospitalized correlated with the patient's reported change in alcohol use after discharge. Recommendations based on these data are being incorporated into the medical education curriculum.     

Psychoactive substance dependence among trauma center patients.

INTRODUCTION--The practice of assessing only trauma patients with elevated blood alcohol concentrations (BACs) or positive drug screens for psychoactive substance use disorders (PSUDs) was evaluated. METHODS--Twenty-four BAC-negative (BAC-) (BAC, 0) and 21 BAC-positive (BAC+) (BAC, greater than or equal to 22 mmol/L or 100 mg/dL; mean, 41 mmol/L; range, 24.3 to 79 mmol/L) adult trauma patients were evaluated for alcoholism and other PSUDs using the Structured Clinical Interview (SCI) from the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R). Approximately half were vehicular crash victims and 78% were men. RESULTS--A total of 64 PSUDs were diagnosed in 31 (68.9%) of the 45 patients; all but one was for dependence (vs abuse). Of the BAC+ patients, 14 (66.7%) met DSM-III-R criteria for alcohol dependence, 11 (78.6%) of whom also had other PSUDs not related to alcohol. Two other BAC+ patients had nonalcohol PSUDs. Of the BAC- patients, 11 (45.8%) had alcohol dependence, six (54.5%) of whom also had nonalcohol PSUDs. Another four BAC- patients had nonalcohol PSUDs. Overall, 76.2% of the BAC+ patients and 62.5% of the BAC- patients had a diagnosis of psychoactive substance dependence. CONCLUSION--All patients admitted to trauma centers should be assessed for alcoholism and other PSUDs.