Department of Emergency Medicine, UCSF-Fresno, Medical Education Program, Fresno, California 93701, USA.
Prehosp Emerg Care. 2009 Oct-Dec;13(4):512-5. doi: 10.1080/10903120903144866.
To compare the prehospital time intervals from patient contact and medication administration to clinical response for intranasal (IN) versus intravenous (IV) naloxone in patients with suspected narcotic overdose.
This was a retrospective review of emergency medical services (EMS) and hospital records, before and after implementation of a protocol for administration of intranasal naloxone by the Central California EMS Agency. We included patients with suspected narcotic overdose treated in the prehospital setting over 17 months, between March 2003 and July 2004. Paramedics documented dose, route of administration, and positive response times using an electronic record. Clinical response was defined as an increase in respiratory rate (breaths/min) or Glasgow Coma Scale score of at least 6. Main outcome variables included time from medication to clinical response and time from patient contact to clinical response. Secondary variables included numbers of doses administered and rescue doses given by an alternate route. Between-group comparisons were accomplished using t-tests and chi-square tests as appropriate.
One hundred fifty-four patients met the inclusion criteria, including 104 treated with IV and 50 treated with IN naloxone. Clinical response was noted in 33 (66%) and 58 (56%) of the IN and IV groups, respectively (p = 0.3). The mean time between naloxone administration and clinical response was longer for the IN group (12.9 vs. 8.1 min, p = 0.02). However, the mean times from patient contact to clinical response were not significantly different between the IN and IV groups (20.3 vs. 20.7 min, p = 0.9). More patients in the IN group received two doses of naloxone (34% vs. 18%, p = 0.05), and three patients in the IN group received a subsequent dose of IV or IM naloxone.
The time from dose administration to clinical response for naloxone was longer for the IN route, but the overall time from patient contact to response was the same for the IV and IN routes. Given the difficulty and potential hazards in obtaining IV access in many patients with narcotic overdose, IN naloxone appears to be a useful and potentially safer alternative.
比较接触患者和给予药物治疗到临床反应的时间间隔，比较经鼻（IN）与静脉（IV）给予纳洛酮治疗疑似阿片类药物过量患者的效果。
这是一项回顾性研究，对中央加利福尼亚州紧急医疗服务（EMS）机构实施经鼻纳洛酮给药方案前后的 EMS 和医院记录进行了研究。我们纳入了在院前环境中治疗的疑似阿片类药物过量患者，研究时间为 2003 年 3 月至 2004 年 7 月，共 17 个月。护理人员使用电子记录记录剂量、给药途径和阳性反应时间。临床反应定义为呼吸频率（次/分钟）或格拉斯哥昏迷评分至少增加 6 分。主要观察变量包括从用药到临床反应的时间和从接触患者到临床反应的时间。次要观察变量包括给药次数和通过替代途径给予的抢救剂量。组间比较采用 t 检验和卡方检验。
共纳入 154 例患者，其中 104 例接受 IV 纳洛酮治疗，50 例接受 IN 纳洛酮治疗。IN 组和 IV 组的临床反应率分别为 66%（33/50）和 56%（58/104）（p=0.3）。IN 组从纳洛酮给药到临床反应的平均时间较长（12.9 分钟 vs. 8.1 分钟，p=0.02）。然而，IN 组和 IV 组从接触患者到临床反应的平均时间无显著差异（20.3 分钟 vs. 20.7 分钟，p=0.9）。IN 组有更多患者接受了两剂纳洛酮（34% vs. 18%，p=0.05），3 例 IN 组患者随后接受了 IV 或 IM 纳洛酮。
IN 途径给予纳洛酮后到临床反应的时间较长，但 IV 途径和 IN 途径从接触患者到反应的总时间相同。鉴于许多阿片类药物过量患者获得 IV 通路存在困难和潜在危险，IN 纳洛酮似乎是一种有用且潜在更安全的替代方法。
