Jeffers Trevor, Darling Brenna, Edwards Christopher, Vadiei Nina
Department of Pharmacy, Banner - University Medical Center South, Tucson, Arizona.
Department of Pharmacy, Banner - University Medical Center Tucson, Tucson, Arizona.
J Emerg Med. 2022 Apr;62(4):516-523. doi: 10.1016/j.jemermed.2022.01.009. Epub 2022 Mar 12.
Antipsychotic and sedative combinations are commonly used for treating agitation in the emergency department despite limited evidence regarding their comparative safety and efficacy.
To compare the efficacy and safety of combination haloperidol, lorazepam, and diphenhydramine (B52) to combination haloperidol and lorazepam (52) in treating acute agitation.
This multicenter, retrospective cohort study included adult patients ≥ 18 years of age who received either B52 or 52 at a Banner Health facility between August 2017 and September 2020. Patients were excluded if they had a pre-existing movement disorder or were withdrawing from alcohol. The primary outcome was administration of additional agitation medication(s) within 2 h of B52 or 52. Secondary outcomes included incidence of extrapyramidal symptoms, length of stay, and additional safety measures.
There was no difference in administration frequency of additional agitation medication(s) (B52: n = 28 [14%] vs. 52: n = 40 [20%]; p = 0.11). Patients who received 52 were more likely to require an antimuscarinic medication within 2 days (15 vs. 6 patients, p = 0.04). Of the patients who received an antimuscarinic medication, none had documented extrapyramidal symptoms. The 52 group had shorter length of stay (13.8 vs. 17 h; p = 0.03), lower incidence of hypotension (7 vs. 32 patients; p < 0.001), and oxygen desaturation (0 vs. 6 patients; p = 0.01), and fewer physical restraints (53 vs. 86 patients; p = 0.001) compared with the B52 group.
Both the B52 and 52 combinations infrequently required repeat agitation medication; however, the B52 combination resulted in more oxygen desaturation, hypotension, physical restraint use, and longer length of stay.
尽管抗精神病药物和镇静药物联合使用在比较安全性和疗效方面的证据有限，但在急诊科中常用于治疗激越症状。
比较氟哌啶醇、劳拉西泮和苯海拉明联合用药（B52）与氟哌啶醇和劳拉西泮联合用药（52）治疗急性激越的疗效和安全性。
这项多中心回顾性队列研究纳入了2017年8月至2020年9月期间在班纳健康机构接受B52或52治疗的18岁及以上成年患者。如果患者有既往运动障碍或正在戒酒，则被排除。主要结局是在使用B52或52后2小时内使用额外的激越治疗药物。次要结局包括锥体外系症状的发生率、住院时间和其他安全措施。
额外激越治疗药物的使用频率没有差异（B52组：n = 28 [14%] 对比52组：n = 40 [20%]；p = 0.11）。接受52治疗的患者在2天内更有可能需要使用抗胆碱能药物（15例对比6例患者，p = 0.04）。在接受抗胆碱能药物治疗的患者中，没有记录到锥体外系症状。与B52组相比，52组的住院时间更短（13.8小时对比17小时；p = 0.03），低血压发生率更低（7例对比32例患者；p < 0.001），氧饱和度下降发生率更低（0例对比6例患者；p = 0.01），使用身体约束的情况更少（53例对比86例患者；p = 0.001）。
B52和52联合用药很少需要重复使用激越治疗药物；然而，B52联合用药导致更多的氧饱和度下降、低血压、身体约束使用和更长的住院时间。
