Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN.
Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN; Department of Emergency Medicine, University of Minnesota Medical School, Minneapolis, MN.
Ann Emerg Med. 2021 Aug;78(2):274-286. doi: 10.1016/j.annemergmed.2021.01.005. Epub 2021 Apr 9.
Intramuscular medications are commonly used to treat agitation in the emergency department (ED). The purpose of this study is to compare intramuscular droperidol and olanzapine for treating agitation.
This was a prospective observational study of ED patients receiving intramuscular droperidol or olanzapine for acute agitation. The treating physician determined the medication and dose; however, over time drug shortages made either olanzapine (July to September 2019) or droperidol (November 2019 to March 2020) unavailable, creating a natural experiment. The primary outcome was time to adequate sedation, assessed by the Altered Mental Status Scale (AMSS), defined as time to AMSS score less than or equal to 0.
We analyzed 1,257 patients (median age 42 years; 73% men); 538 received droperidol (median dose 5 mg) and 719 received olanzapine (median dose 10 mg). The majority of patients (1,086; 86%) had agitation owing to alcohol intoxication. Time to adequate sedation was 16 minutes (interquartile range 10 to 30 minutes) for droperidol and 17.5 minutes (interquartile range 10 to 30 minutes) for olanzapine (absolute difference -0.7 minutes; 95% confidence interval -2.1 to 0.5 minutes). Adjusted Cox proportional hazard model analysis revealed no difference between groups in time to sedation (hazard ratio for adequate sedation for droperidol compared with olanzapine 1.12; 95% confidence interval 1.00 to 1.25). Patients receiving olanzapine were more likely to receive additional medications for sedation (droperidol 17%; olanzapine 24%; absolute difference -8% [95% confidence interval -12% to -3%]). We observed no difference between drugs regarding adverse effects except for extrapyramidal adverse effects, which were more common with droperidol (n=6; 1%) than olanzapine (n=1; 0.1%).
We found no difference in time to adequate sedation between intramuscular droperidol and olanzapine.
肌肉内给药常用于治疗急诊科（ED）的激越。本研究的目的是比较肌肉内注射氟哌啶醇和奥氮平治疗激越。
这是一项对接受肌肉内注射氟哌啶醇或奥氮平治疗急性激越的 ED 患者的前瞻性观察性研究。治疗医生决定药物和剂量；然而，随着时间的推移，奥氮平（2019 年 7 月至 9 月）或氟哌啶醇（2019 年 11 月至 2020 年 3 月）短缺，造成了自然实验。主要结局是通过改变精神状态量表（AMSS）评估的充分镇静时间，定义为 AMSS 评分小于或等于 0 的时间。
我们分析了 1257 例患者（中位年龄 42 岁；73%为男性）；538 例患者接受氟哌啶醇（中位剂量 5mg），719 例患者接受奥氮平（中位剂量 10mg）。大多数患者（1086 例；86%）因酒精中毒引起激越。氟哌啶醇的充分镇静时间为 16 分钟（四分位间距 10 至 30 分钟），奥氮平为 17.5 分钟（四分位间距 10 至 30 分钟）（绝对差异-0.7 分钟；95%置信区间-2.1 至 0.5 分钟）。调整后的 Cox 比例风险模型分析显示，两组在镇静时间上无差异（氟哌啶醇与奥氮平相比，充分镇静的风险比为 1.12；95%置信区间 1.00 至 1.25）。接受奥氮平的患者更有可能接受额外的镇静药物（氟哌啶醇 17%；奥氮平 24%；绝对差异-8%[95%置信区间-12%至-3%]）。除了锥体外系不良反应外，我们没有观察到两种药物之间在不良反应方面存在差异，而氟哌啶醇（6 例；1%）比奥氮平（1 例；0.1%）更常见。
我们发现肌肉内注射氟哌啶醇和奥氮平在充分镇静时间上没有差异。
