Wilson Michael P, MacDonald Kai, Vilke Gary M, Feifel David
Department of Emergency Medicine, University of California, San Diego Medical Center, San Diego, California 92103, USA.
J Emerg Med. 2012 Nov;43(5):790-7. doi: 10.1016/j.jemermed.2011.01.024. Epub 2011 May 20.
Pharmacologic management of the agitated emergency department patient is controversial. The combination of olanzapine + benzodiazepines is not recommended by the manufacturer, but a recent report suggested harm only if the patient was intoxicated. Whether this is also true for haloperidol + benzodiazepines is not known.
The measurement of vital signs and ethanol levels in patients who received haloperidol with or without benzodiazepines was compared to a previous analysis of patients who received olanzapine with or without benzodiazepines.
This is a structured retrospective chart review of patients who received parenteral haloperidol or parental olanzapine either with or without benzodiazepines.
There were 96 patients (71 haloperidol, 25 olanzapine) who met inclusion criteria. No patient in the olanzapine + benzodiazepine group had hypotension, although one patient in the olanzapine-only group did (6.7%); 2 patients in the haloperidol + benzodiazepines group (5.1%) and 2 patients in the haloperidol-only group (6.3%) had hypotension. In alcohol-negative (ETOH-) patients, neither olanzapine alone nor olanzapine + benzodiazepines was associated with decreased oxygen saturations. In ETOH+ patients, olanzapine alone was not associated with decreased oxygen saturations, but olanzapine + benzodiazepines were associated with lower oxygen saturations than haloperidol + benzodiazepines.
In this sample, olanzapine alone or with a benzodiazepine was not associated with more hypotension than haloperidol. However, olanzapine + benzodiazepines were associated with lower oxygen saturations than haloperidol + benzodiazepines in ETOH+ but not ETOH- patients. In patients with known alcohol ingestion, haloperidol, haloperidol + benzodiazepines, or olanzapine alone may be better choices for treatment of agitation.
急诊科躁动患者的药物管理存在争议。奥氮平与苯二氮䓬类药物联合使用未获制造商推荐，但最近一份报告表明，仅在患者中毒时才会有危害。对于氟哌啶醇与苯二氮䓬类药物联合使用是否也是如此尚不清楚。
将接受氟哌啶醇（无论是否联用苯二氮䓬类药物）患者的生命体征和乙醇水平测量结果，与之前接受奥氮平（无论是否联用苯二氮䓬类药物）患者的分析结果进行比较。
这是一项对接受胃肠外氟哌啶醇或胃肠外奥氮平（无论是否联用苯二氮䓬类药物）患者的结构化回顾性病历审查。
有96例患者（71例使用氟哌啶醇，25例使用奥氮平）符合纳入标准。奥氮平 + 苯二氮䓬类药物组中无患者出现低血压，尽管奥氮平单药组中有1例患者出现低血压（6.7%）；氟哌啶醇 + 苯二氮䓬类药物组中有2例患者（5.1%）和氟哌啶醇单药组中有2例患者（6.3%）出现低血压。在酒精阴性（ETOH-）患者中，单独使用奥氮平或奥氮平 + 苯二氮䓬类药物均与氧饱和度降低无关。在ETOH+患者中，单独使用奥氮平与氧饱和度降低无关，但奥氮平 + 苯二氮䓬类药物组的氧饱和度低于氟哌啶醇 + 苯二氮䓬类药物组。
在本样本中，单独使用奥氮平或联用苯二氮䓬类药物与氟哌啶醇相比，引发低血压的情况并不更多。然而，在ETOH+患者而非ETOH-患者中，奥氮平 + 苯二氮䓬类药物组的氧饱和度低于氟哌啶醇 + 苯二氮䓬类药物组。对于已知有酒精摄入的患者，单独使用氟哌啶醇、氟哌啶醇 + 苯二氮䓬类药物或奥氮平可能是治疗躁动的更好选择。
