头痛在急诊科的治疗比较：丙氯拉嗪与氯胺酮。
A Comparison of Headache Treatment in the Emergency Department: Prochlorperazine Versus Ketamine.
机构信息
Department of Emergency Medicine, University of Nevada, Reno School of Medicine, Las Vegas, NV; Department of Emergency Medicine, University of Nevada, Las Vegas School of Medicine, Las Vegas, NV; Department of Emergency Medicine, University Medical Center of Southern Nevada, Las Vegas, NV.
Department of Emergency Medicine, University of Nevada, Reno School of Medicine, Las Vegas, NV.
出版信息
Ann Emerg Med. 2018 Mar;71(3):369-377.e1. doi: 10.1016/j.annemergmed.2017.08.063. Epub 2017 Oct 14.
STUDY OBJECTIVE
Intravenous subdissociative-dose ketamine has been shown to be effective for pain management, but has not been specifically studied for headaches in the emergency department (ED). For this reason, we designed a study to compare standard treatment (prochlorperazine) with ketamine in patients with benign headaches in the ED.
METHODS
This study was a multicenter, double-blind, randomized, controlled trial with a convenience sample of patients presenting to the ED with benign headaches. Patients were randomized to receive either prochlorperazine and diphenhydramine or ketamine and ondansetron. Patients' headache severity was measured on a 100-mm visual analog scale (VAS) at 0, 15, 30, 45, and 60 minutes. Nausea, vomiting, anxiety, and the need for rescue medications were also tracked. Patients were contacted at 24 to 48 hours posttreatment to rate their satisfaction and to determine whether they were still experiencing a headache.
RESULTS
There were a total of 54 subjects enrolled. Two patients in the ketamine group and one in the prochlorperazine group withdrew because of adverse effects of the medications. In regard to the primary outcome, at 60 minutes, the prochlorperazine group had a mean improvement in VAS pain scores of 63.5 mm compared with 43.5 mm in the ketamine group, corresponding to a between-groups difference of 20.0 mm (95% confidence interval [CI] 2.8 to 37.2 mm) and a P value of .026. At 45 minutes, the prochlorperazine group had a mean improvement in pain scores of 56.1 mm compared with 38.0 mm in the ketamine group, a difference of 18.1 mm (95% CI 1.0 to 35.2 mm). At 24- to 48-hour follow-up, the mean satisfaction score was 8.3 of 10 for prochlorperazine and 4.9 of 10 for ketamine, a difference of 3.4 (95% CI 1.2 to 5.6). There was not a statistically significant difference in the percentage of patients who had a headache at follow-up or in other secondary outcomes.
CONCLUSION
Prochlorperazine appears to be superior to ketamine for the treatment of benign headaches in the ED.
研究目的
静脉亚分离剂量氯胺酮已被证明可有效用于疼痛管理，但尚未专门针对急诊科（ED）的头痛进行研究。出于这个原因，我们设计了一项研究，以比较 ED 中良性头痛患者的标准治疗（丙氯拉嗪）与氯胺酮。
方法
这是一项多中心、双盲、随机、对照试验，采用便利抽样方法，纳入就诊于 ED 的良性头痛患者。患者被随机分配接受丙氯拉嗪和苯海拉明或氯胺酮和昂丹司琼治疗。患者的头痛严重程度在 0、15、30、45 和 60 分钟时通过 100 毫米视觉模拟量表（VAS）进行测量。还跟踪了恶心、呕吐、焦虑和需要抢救药物的情况。患者在治疗后 24 至 48 小时内进行联系，以评估他们的满意度并确定他们是否仍有头痛。
结果
共有 54 名患者入组。氯胺酮组有 2 名患者和丙氯拉嗪组有 1 名患者因药物不良反应而退出。关于主要结局，在 60 分钟时，丙氯拉嗪组的 VAS 疼痛评分平均改善 63.5 毫米，而氯胺酮组为 43.5 毫米，组间差异为 20.0 毫米（95%置信区间 [CI] 2.8 至 37.2 毫米），P 值为.026。在 45 分钟时，丙氯拉嗪组的疼痛评分平均改善 56.1 毫米，而氯胺酮组为 38.0 毫米，差异为 18.1 毫米（95%CI 1.0 至 35.2 毫米）。在 24 至 48 小时随访时，丙氯拉嗪的平均满意度评分为 10 分中的 8.3 分，而氯胺酮的平均满意度评分为 10 分中的 4.9 分，差异为 3.4（95%CI 1.2 至 5.6）。在随访时头痛患者的百分比或其他次要结局方面，没有统计学上的显著差异。
结论
在 ED 中，丙氯拉嗪似乎优于氯胺酮治疗良性头痛。
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