Kendrick Jennifer G, Goldman Ran D, Carr Roxane R
J Pediatr Pharmacol Ther. 2018 Nov-Dec;23(6):455-459. doi: 10.5863/1551-6776-23.6.455.
Benzodiazepine and antipsychotic use for acute management of agitation and aggression in the pediatric emergency department (ED) setting has not been well described.
To describe medication utilization in the management of agitation and aggression in a pediatric ED and to assess the safety of their use.
This was a retrospective observational study. Patients less than 20 years of age who presented to our pediatric ED and had agitation or aggression as part of their chief complaint were included if they received at least 1 dose of benzodiazepine or antipsychotic. Outcomes included frequency of benzodiazepine and antipsychotic use, dosing of medications, and reported adverse events.
During the 5-year study period, there were 128 visits of 120 patients who met the inclusion criteria. Lorazepam was most commonly given (70%), followed by chlorpromazine (20%). Most patients (82%) required a single dose of medication. Intoxication was associated with needing more than 1 dose of medication. Patients with autism or Asperger syndrome were more likely to receive an antipsychotic medication compared to not having these conditions (75% vs. 28%, respectively). Adverse events were documented in 6 visits: oxygen desaturation (n = 1), dizziness and nausea (n = 2), dizziness (n = 1), and paradoxical excitation (n = 2). The Naranjo Score indicated a probable adverse drug reaction for the cases of paradoxical excitation.
Benzodiazepine and antipsychotic drug therapy for acute agitation and aggression in children appears to be safe and well tolerated when used as a single agent and at the recommended doses in this setting.
在儿科急诊科（ED）环境中，使用苯二氮䓬类药物和抗精神病药物对躁动和攻击行为进行急性处理的情况尚未得到充分描述。
描述儿科急诊科在处理躁动和攻击行为时的药物使用情况，并评估其使用安全性。
这是一项回顾性观察研究。纳入年龄小于20岁、因躁动或攻击行为为主诉前来我院儿科急诊科就诊且至少接受过1剂苯二氮䓬类药物或抗精神病药物治疗的患者。观察指标包括苯二氮䓬类药物和抗精神病药物的使用频率、药物剂量以及报告的不良事件。
在为期5年的研究期间，共有120例患者的128次就诊符合纳入标准。最常使用的是劳拉西泮（70%），其次是氯丙嗪（20%）。大多数患者（82%）只需一剂药物。中毒与需要一剂以上药物有关。与没有自闭症或阿斯伯格综合征的患者相比，患有自闭症或阿斯伯格综合征的患者更有可能接受抗精神病药物治疗（分别为75%和28%）。有6次就诊记录了不良事件：氧饱和度下降（n = 1）、头晕和恶心（n = 2）、头晕（n = 1）以及矛盾性兴奋（n = 2）。Naranjo评分表明矛盾性兴奋病例可能为药物不良反应。
在这种情况下，将苯二氮䓬类药物和抗精神病药物作为单一药物并按推荐剂量用于儿童急性躁动和攻击行为的治疗似乎是安全且耐受性良好的。
