Riddell Jeff, Tran Alexander, Bengiamin Rimon, Hendey Gregory W, Armenian Patil
Division of Emergency Medicine, University of Washington, Seattle, WA, USA.
St. Louis University School of Medicine, USA.
Am J Emerg Med. 2017 Jul;35(7):1000-1004. doi: 10.1016/j.ajem.2017.02.026. Epub 2017 Feb 13.
Emergency physicians often need to control agitated patients who present a danger to themselves and hospital personnel. Commonly used medications have limitations. Our primary objective was to compare the time to a defined reduction in agitation scores for ketamine versus benzodiazepines and haloperidol, alone or in combination. Our secondary objectives were to compare rates of medication redosing, vital sign changes, and adverse events in the different treatment groups.
We conducted a single-center, prospective, observational study examining agitation levels in acutely agitated emergency department patients between the ages of 18 and 65 who required sedation medication for acute agitation. Providers measured agitation levels on a previously validated 6-point sedation scale at 0-, 5-, 10-, and 15-min after receiving sedation. We also assessed the incidence of adverse events, repeat or rescue medication dosing, and changes in vital signs.
106 patients were enrolled and 98 met eligibility criteria. There was no significant difference between groups in initial agitation scores. Based on agitation scores, more patients in the ketamine group were no longer agitated than the other medication groups at 5-, 10-, and 15-min after receiving medication. Patients receiving ketamine had similar rates of redosing, changes in vital signs, and adverse events to the other groups.
In highly agitated and violent emergency department patients, significantly fewer patients receiving ketamine as a first line sedating agent were agitated at 5-, 10-, and 15-min. Ketamine appears to be faster at controlling agitation than standard emergency department medications.
急诊医生常常需要控制那些对自身及医院工作人员构成危险的躁动患者。常用药物存在局限性。我们的主要目的是比较氯胺酮与苯二氮䓬类药物及氟哌啶醇单独使用或联合使用时，使躁动评分降至规定水平所需的时间。我们的次要目的是比较不同治疗组的药物重复给药率、生命体征变化及不良事件发生率。
我们进行了一项单中心、前瞻性、观察性研究，对年龄在18至65岁之间、因急性躁动需要使用镇静药物的急诊急性躁动患者的躁动水平进行检查。医护人员在患者接受镇静治疗后的0、5、10和15分钟，使用先前验证过的6分镇静量表测量躁动水平。我们还评估了不良事件的发生率、重复或急救药物给药情况以及生命体征的变化。
共纳入106例患者，98例符合入选标准。各组初始躁动评分无显著差异。根据躁动评分，在接受药物治疗后的5、10和15分钟，氯胺酮组不再躁动的患者比其他药物组更多。接受氯胺酮治疗的患者在重复给药率、生命体征变化及不良事件发生率方面与其他组相似。
在高度躁动和暴力的急诊患者中，作为一线镇静剂使用氯胺酮的患者在5、10和15分钟时躁动的人数明显较少。氯胺酮在控制躁动方面似乎比标准的急诊药物更快。
