Yeo Qiu Min, Wiley Tessa L, Smith Melanie N, Hammond Drayton A
Department of Pharmacy, Changi General Hospital, Singapore (Dr Yeo); Department of Pharmacy, The University of Mississippi Medical Center, Jackson (Dr Wiley); Department of Pharmacy, Medical University of South Carolina, Charleston (Dr Smith); and Department of Pharmacy, Rush University Medical Center, Chicago, Illinois (Dr Hammond).
Crit Care Nurs Q. 2017 Oct/Dec;40(4):344-362. doi: 10.1097/CNQ.0000000000000172.
Agitation is one of the most common issues that critically ill patients experience. Medications used to manage agitation are often administered intravenously or intramuscularly in the acutely agitated, critically ill patient. However, a multimodal approach that utilizes multiple routes of administration may be appropriate. This review summarizes the available literature on oral antipsychotics, clonidine, and valproic acid to manage agitation in critically ill patients while also focusing on their pharmacology and appropriate monitoring. Despite inconclusive findings from different studies, antipsychotics, clonidine, and valproic acid may provide benefit for specific patient populations. As more evidence emerges, these agents may start playing a greater role in the management of agitation, which is not amenable to first-line agents. As health care professionals, it is prudent to be familiar with their dosing regimens, common adverse effects, and the monitoring required to maximize patient benefits and minimize harms.
躁动是重症患者最常见的问题之一。用于控制躁动的药物通常通过静脉注射或肌肉注射给予急性躁动的重症患者。然而，采用多种给药途径的多模式方法可能是合适的。这篇综述总结了关于口服抗精神病药物、可乐定和丙戊酸用于控制重症患者躁动的现有文献，同时关注它们的药理学及适当的监测。尽管不同研究的结果尚无定论，但抗精神病药物、可乐定和丙戊酸可能对特定患者群体有益。随着更多证据的出现，这些药物可能开始在难以用一线药物控制的躁动管理中发挥更大作用。作为医疗保健专业人员，熟悉它们的给药方案、常见不良反应以及为使患者受益最大化和危害最小化所需的监测是审慎之举。
