Macht Marlow, Mull Ashley C, McVaney Kevin E, Caruso Emily H, Johnston J Bill, Gaither Joshua B, Shupp Aaron M, Marquez Kevin D, Haukoos Jason S, Colwell Christopher B
Prehosp Emerg Care. 2014 Jul-Sep;18(3):375-80. doi: 10.3109/10903127.2013.864353. Epub 2014 Jan 24.
Since the 2001 "black box" warning on droperidol, its use in the prehospital setting has decreased substantially in favor of haloperidol. There are no studies comparing the prehospital use of either drug. The goal of this study was to compare QTc prolongation, adverse events, and effectiveness of droperidol and haloperidol among a cohort of agitated patients in the prehospital setting.
In this institutional review board-approved before and after study, we collected data on 532 patients receiving haloperidol (n = 314) or droperidol (n = 218) between 2007 and 2010. We reviewed emergency department (ED) electrocardiograms when available (haloperidol, n = 78, 25%; droperidol, n = 178, 76%) for QTc length (in milliseconds), medical records for clinically relevant adverse events (defined a priori as systolic blood pressure (SBP) <90 mmHg, seizure, administration of anti-dysrhythmic medications, cardioversion or defibrillation, bag-valve-mask ventilation, intubation, cardiopulmonary arrest, and prehospital or in-hospital death). We also compared effectiveness of the medications, using administration of additional sedating medications within 30 minutes of ED arrival as a proxy for effectiveness.
The mean haloperidol dose was 7.9 mg (median 10 mg, range 4-20 mg). The mean droperidol dose was 2.9 mg (median 2.5 mg, range 1.25-10 mg.) Haloperidol was given i.m. in 289 cases (92%), and droperidol was given i.m. in 132 cases (61%); in all other cases, the medication was given i.v.. There was no statistically significant difference in median QTc after medication administration (haloperidol 447 ms, 95% CI: 440-454 ms; droperidol 454 ms, 95% CI: 450-457). There were no statistically significant differences in adverse events in the droperidol group as compared to the haloperidol group. One patient in the droperidol group with a history of congenital heart disease suffered a cardiopulmonary arrest and was resuscitated with neurologically intact survival. There was no significant difference in the use of additional sedating medications within 30 minutes of ED arrival after receiving droperidol (2.9%, 95% CI: -2.5-8.4%).
In this cohort of agitated patients treated with haloperidol or droperidol in the prehospital setting, there was no significant difference found in QTc prolongation, adverse events, or need for repeat sedation between haloperidol and droperidol.
自2001年氟哌利多被贴上“黑框”警告标签后，其在院前环境中的使用量大幅下降，转而青睐于使用氟哌啶醇。目前尚无比较这两种药物在院前使用情况的研究。本研究的目的是比较在院前环境中一组躁动患者使用氟哌利多和氟哌啶醇后的QTc延长情况、不良事件及有效性。
在这项经机构审查委员会批准的前后对照研究中，我们收集了2007年至2010年间532例接受氟哌啶醇（n = 314）或氟哌利多（n = 218）治疗患者的数据。若有急诊室（ED）心电图（氟哌啶醇，n = 78，25%；氟哌利多，n = 178，76%），则审查QTc时长（以毫秒为单位），查阅病历以了解临床相关不良事件（预先定义为收缩压（SBP）<90 mmHg、癫痫发作、使用抗心律失常药物、心脏复律或除颤、袋阀面罩通气、插管、心肺骤停以及院前或院内死亡）。我们还比较了药物的有效性，以患者到达急诊室后30分钟内使用额外镇静药物作为有效性的替代指标。
氟哌啶醇的平均剂量为7.9 mg（中位数10 mg，范围4 - 20 mg）。氟哌利多的平均剂量为2.9 mg（中位数2.5 mg，范围1.25 - 10 mg）。氟哌啶醇有289例（92%）采用肌内注射给药，氟哌利多有132例（61%）采用肌内注射给药；在所有其他情况下，药物通过静脉注射给药。给药后中位数QTc无统计学显著差异（氟哌啶醇447 ms，95% CI：440 - 454 ms；氟哌利多454 ms，95% CI：450 - 457）。与氟哌啶醇组相比，氟哌利多组的不良事件无统计学显著差异。氟哌利多组中有1例有先天性心脏病史的患者发生了心肺骤停，经复苏后神经功能完好存活。接受氟哌利多治疗后，患者到达急诊室30分钟内使用额外镇静药物的情况无显著差异（2.9%，95% CI： - 2.5 - 8.4%）。
在这组院前接受氟哌啶醇或氟哌利多治疗的躁动患者中，氟哌利多和氟哌啶醇在QTc延长、不良事件或重复镇静需求方面未发现显著差异。
