Discipline of Clinical Pharmacology, University of Newcastle, New South Wales, Australia.
BMC Psychiatry. 2013 Sep 18;13:225. doi: 10.1186/1471-244X-13-225.
Acute behavioural disturbance (ABD) is a common problem in psychiatry and both physical restraint and involuntary parenteral sedation are often required to control patients. Although guidelines are available, clinical practice is often guided by experience and there is little agreement on which drugs should be first-line treatment for rapid tranquilisation. This study aimed to investigate sedation for ABD in an acute mental healthcare unit, including the effectiveness and safety of high dose sedation.
A prospective study of parenteral sedation for ABD in mental health patients was conducted from July 2010 to June 2011. Drug administration (type, dose, additional doses), time to sedation, vital signs and adverse effects were recorded. High dose parenteral sedation was defined as greater than the equivalent of 10 mg midazolam, droperidol or haloperidol (alone or in combination), compared to patients receiving 10 mg or less (normal dose). Effective sedation was defined as a fall in the sedation assessment tool score by two or a score of zero or less. Outcomes included frequency of adverse drug effects, time to sedation/tranquilisation and use of additional sedation.
Parenteral sedation was given in 171 cases. A single drug was given in 96 (56%), including droperidol (74), midazolam (19) and haloperidol (3). Effective sedation occurred in 157 patients (92%), and the median time to sedation was 20 min (Range: 5 to 100 min). The median time to sedation for 93 patients receiving high dose sedation was 20 min (5-90 min) compared to 20 min (5-100 min; p = 0.92) for 78 patients receiving normal dose sedation. Adverse effects occurred in 16 patients (9%); hypotension (14), oxygen desaturation (1), hypotension and oxygen desaturation (1). There were more adverse effects in the high dose sedation group compared to the normal dose group [11/93 (12%) vs. 5/78 (6%); p = 0.3]. Additional sedation was given in 9 of 171 patients (5%), seven in the high dose and two in the normal dose groups.
Large initial doses of sedative drugs were used for ABD in just over half of cases and additional sedation was uncommon. High dose sedation did not result in more rapid or effective sedation but was associated with more adverse effects.
急性行为障碍（ABD）是精神病学中的一个常见问题，通常需要身体约束和非自愿的静脉镇静来控制患者。尽管有指南，但临床实践通常是基于经验，并且对于哪种药物应该作为快速镇静的一线治疗药物，意见并不一致。本研究旨在调查精神科急症病房的 ABD 镇静治疗，包括大剂量镇静的效果和安全性。
对 2010 年 7 月至 2011 年 6 月期间精神科患者进行的 ABD 静脉镇静治疗进行前瞻性研究。记录药物使用（类型、剂量、追加剂量）、镇静时间、生命体征和不良反应。高剂量静脉镇静定义为大于 10mg 咪达唑仑、氟哌啶醇或氟哌啶醇（单独或联合使用），而接受 10mg 或以下剂量镇静的患者则为正常剂量。有效镇静定义为镇静评估工具评分下降 2 分或评分降至 0 或以下。结果包括药物不良反应频率、镇静/安定时间和追加镇静药物的使用。
171 例患者接受了静脉镇静治疗。96 例（56%）患者使用了单一药物，其中氟哌啶醇 74 例，咪达唑仑 19 例，氟哌啶醇 3 例。157 例（92%）患者镇静有效，中位镇静时间为 20 分钟（范围：5-100 分钟）。93 例接受大剂量镇静治疗的患者的中位镇静时间为 20 分钟（5-90 分钟），而 78 例接受正常剂量镇静治疗的患者的中位镇静时间为 20 分钟（5-100 分钟；p=0.92）。16 例（9%）患者发生不良反应，其中低血压 14 例，氧饱和度下降 1 例，低血压和氧饱和度下降 1 例。高剂量镇静组的不良反应发生率高于正常剂量镇静组[11/93（12%）比 5/78（6%）；p=0.3]。171 例患者中有 9 例（5%）追加镇静，其中 7 例在高剂量镇静组，2 例在正常剂量镇静组。
半数以上的 ABD 患者使用了较大初始剂量的镇静药物，追加镇静药物的使用并不常见。高剂量镇静并未使镇静更快或更有效，但与更多不良反应相关。
