Prehosp Emerg Care. 2019 Jul-Aug;23(4):519-526. doi: 10.1080/10903127.2018.1542473. Epub 2018 Dec 7.
Although uncommon, children (<16 years) with acute behavioral disturbance are a significant issue for emergency medical service providers. In this study, we aimed to investigate the safety and effectiveness of droperidol in children with prehospital acute behavioral disturbance. This was a prospective observational study over 1 year investigating the use of droperidol (0.1-0.2 mg/kg) for children (< 16 years) with acute behavioral disturbance. Inclusion criteria for acute behavioral disturbance were defined by a sedation assessment tool score of ≥2 determined by the attending paramedic. The primary outcome was the proportion of adverse effects (need for airway intervention, oxygen saturation <90% and/or respiratory rate <12, systolic blood pressure <90 mmHg, sedation assessment tool score of -3 and dystonic reactions). Secondary outcomes included time to sedation (sedation assessment tool score decreased by 2 or more, or a score of zero), requirement for additional sedation, failure to sedate and proportion of sedation success defined as the number of patients successfully sedated who did not suffer any adverse events or receive additional sedation. There were 96 patients (males 51 [53%], median age 14 years [range 7-15 years]) who presented on 102 occasions over the one year study period. Self-harm and/or harm to others was the commonest (74/105 [70%]) cause of acute behavioral disturbance followed by alcohol (16/105 [15%]). There were 9 adverse events in 8 patients (8/102 [8%]; 95% confidence intervals [CI]: 3-13%) Five patients had hypotension, all asymptomatic and only one required treatment; 2 dystonic reactions managed with benztropine and one patient with respiratory depression. Median time to sedation was 14 min (interquartile range (IQR): 10-20 min; range: 3-85 min). There was no requirement for prehospital additional sedation (0/102 [0%]; 95% CI: 0-4%) and additional sedation in the first hour of arrival to hospital was required by 4 patients (4/102 [4%]; 95% CI: 1-10%). Overall successful sedation was achieved in 89 (87%) patients. The use of droperidol in children for acute behavioral disturbance in the prehospital setting is both safe and effective.
虽然不常见，但患有急性行为障碍的儿童（<16 岁）是急诊医疗服务提供者面临的一个重大问题。在这项研究中，我们旨在调查在院前患有急性行为障碍的儿童中使用氟哌啶醇的安全性和有效性。 这是一项为期 1 年的前瞻性观察研究，调查了氟哌啶醇（0.1-0.2mg/kg）在急性行为障碍儿童中的应用。急性行为障碍的纳入标准定义为由值班护理人员确定的镇静评估工具评分≥2。主要结局是不良事件的比例（需要气道干预、氧饱和度<90%和/或呼吸频率<12、收缩压<90mmHg、镇静评估工具评分-3 和张力障碍反应）。次要结局包括镇静时间（镇静评估工具评分降低 2 或更多，或评分为 0）、需要额外镇静、镇静失败和镇静成功率的比例（成功镇静的患者数量，无不良事件或接受额外镇静）。 在为期 1 年的研究期间，共有 96 名患者（男性 51 名[53%]，中位年龄 14 岁[范围 7-15 岁]）在 102 次就诊中接受了治疗。自我伤害和/或伤害他人是最常见（74/105[70%]）的急性行为障碍原因，其次是酒精（16/105[15%]）。8 名患者（8/102[8%]；95%置信区间[CI]：3-13%）出现 9 起不良事件。5 名患者出现低血压，均无症状，仅 1 名患者需要治疗；2 名张力障碍反应用苯海索治疗，1 名患者出现呼吸抑制。镇静中位时间为 14 分钟（四分位距（IQR）：10-20 分钟；范围：3-85 分钟）。院前无需额外镇静（0/102[0%]；95%CI：0-4%），102 名患者中 4 名（4/102[4%]；95%CI：1-10%）在到达医院的第一个小时内需要额外镇静。89 名（87%）患者总体镇静成功。氟哌啶醇在院前环境中用于儿童急性行为障碍既安全又有效。
