Moritz F, Bauer F, Boyer A, Lemarchand P, Kerleau J M, Moirot E, Navarre C, Muller J M
Service d'Accueil et d'Urgences Adulte, Hôpital Charles Nicolle, CHU Rouen.
Presse Med. 1999 Oct 9;28(30):1630-4.
To determine the incidence and causes of agitation states in patients presenting at the Rouen University Hospital emergency room and to analyze the management scheme.
A prospective study was conducted over a 9 month period in 100 consecutive patients presenting a state of agitation assessed using the Overt Aggression Scale. A pre-planned management protocol was applied.
The incidence of states of agitation was 0.56%. There were 43 women and 57 men, mean age 33 years. Most of the agitated patients were admitted between 6 p.m. and 4 a.m. (69%). Over the 9 month period, 2 patients were admitted twice for agitation and 2 absconded. Low glucose level was the cause of agitation in 4 cases. Alcohol and/or drug use concerned 73% of the agitated patients and was the most frequently observed triggering factor (17%). Only 6% of the patients had a regular employment. Physical restraining measures and sedation were required in 86% and 84% of the cases respectively. Among 67 patients given loxapine for sedation, 2 developed acute dyskinesia and 9 low blood pressure. One out of 4 patients were referred to a psychiatric unit.
Patients in a state of agitation are young, often female, and in a difficult socio-economic situation. Hypoglycemia is the main differential diagnosis. A triggering factor can often be identified. A state of agitation is not a repetitive condition but occurs as a short-lived episode in the patientís history. Such patients need rapid care to avoid further aggravation and disruption of the emergency room activity, and to prevent the patient from fleeing. Loxapine provides effective sedation but requires regular monitoring of blood pressure and can provoke acute dyskinesia in young subjects.
确定鲁昂大学医院急诊室就诊患者中激越状态的发生率及病因，并分析管理方案。
对连续100例使用公开攻击量表评估为激越状态的患者进行了为期9个月的前瞻性研究。应用预先制定的管理方案。
激越状态的发生率为0.56%。其中女性43例，男性57例，平均年龄33岁。大多数激越患者在下午6点至凌晨4点入院（69%）。在9个月期间，有2例患者因激越再次入院，2例潜逃。低血糖是4例激越的原因。73%的激越患者涉及酒精和/或药物使用，是最常观察到的触发因素（17%）。只有6%的患者有固定工作。分别有86%和84%的病例需要采取身体约束措施和镇静。在67例使用洛沙平镇静的患者中，2例出现急性运动障碍，9例出现低血压。4例患者中有1例被转诊至精神科。
激越状态的患者年轻，多为女性，社会经济状况不佳。低血糖是主要的鉴别诊断。通常可以确定触发因素。激越状态不是一种重复性疾病，而是患者病史中的短暂发作。此类患者需要快速治疗，以避免急诊室活动进一步恶化和中断，并防止患者逃跑。洛沙平提供有效的镇静作用，但需要定期监测血压，且可能在年轻患者中引发急性运动障碍。
