Zun Leslie S
Chair, Department of Emergency Medicine, Chicago Medical School, Chicago, Illinois and Attending, Department of Emergency Medicine, Mount Sinai Hospital, Chicago, Illinois.
J Emerg Med. 2018 Apr;54(4):522-532. doi: 10.1016/j.jemermed.2017.11.031. Epub 2018 Feb 9.
The management of acute agitation in the emergency department often requires the administration of rapid-acting antipsychotic agents. However, there are few comparative studies and little guidance regarding the risks associated with use of such drugs in the acute setting.
This structured evidence-based review compared the safety of antipsychotic pharmacotherapies for acute agitation using data from randomized controlled trials identified by a literature search of the PubMed database.
Based on findings from 34 blinded, randomized controlled trials, common acute adverse effects of second-generation antipsychotics and haloperidol were headache, dizziness, insomnia, and somnolence. There were some differences in incidence of extrapyramidal symptoms (EPS), degree of sedation, and acute QTc prolongations between agents.
The results of this review demonstrate the improved safety (particularly regarding EPS and over-sedation) of certain newer-generation antipsychotic agents compared with haloperidol and benzodiazepines for the treatment of acutely agitated patients. The risk of prolonged QT interval and torsade de pointes needs to be considered with haloperidol and some of the second-generation antipsychotics.
急诊科急性躁动的处理通常需要使用速效抗精神病药物。然而，关于此类药物在急性情况下使用风险的比较研究较少，指导也很少。
本基于证据的结构化综述使用通过检索PubMed数据库确定的随机对照试验数据，比较了抗精神病药物治疗急性躁动的安全性。
基于34项双盲随机对照试验的结果，第二代抗精神病药物和氟哌啶醇常见的急性不良反应为头痛、头晕、失眠和嗜睡。不同药物之间在锥体外系症状（EPS）发生率、镇静程度和急性QTc延长方面存在一些差异。
本综述结果表明，与氟哌啶醇和苯二氮䓬类药物相比，某些新一代抗精神病药物在治疗急性躁动患者时安全性更高（尤其是在EPS和过度镇静方面）。使用氟哌啶醇和某些第二代抗精神病药物时，需要考虑QT间期延长和尖端扭转型室速的风险。
