肌肉注射 1.6 毫克纳洛酮后出现急性阿片类药物戒断：一项前瞻性院外系列研究。
Acute Opioid Withdrawal Following Intramuscular Administration of Naloxone 1.6 mg: A Prospective Out-Of-Hospital Series.
机构信息
Clinical Toxicology Unit, Princess Alexandra, Hospital, Brisbane, Australia; Clinical Toxicology Research Group, University of Newcastle, Newcastle, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia.
Medical Director's Office, Queensland Ambulance Service, Brisbane, Australia.
出版信息
Ann Emerg Med. 2022 Aug;80(2):120-126. doi: 10.1016/j.annemergmed.2022.03.004. Epub 2022 Apr 29.
STUDY OBJECTIVE
Large doses of intramuscular (IM) naloxone are commonly used in out-of-hospital settings to reverse opioid toxicity; however, they are used less commonly in hospitals because of concerns about opioid withdrawal, particularly agitation. We aimed to determine the frequency of severe agitation following a single 1.6 mg IM naloxone dose.
METHODS
We undertook a prospective study of adult (>15 years) patients treated by an Australian state ambulance service with 1.6 mg IM administration of naloxone for respiratory depression (respiratory rate <11 breaths/min and/or oxygen saturation <93% in room air) caused by presumed opioid poisoning. The primary outcome was the proportion of presentations with severe agitation (Sedation Assessment Tool score >1) within 1 hour of naloxone administration. Secondary outcomes were the proportion of presentations with acute opioid withdrawal (tachycardia [pulse rate >100 beats/min], hypertension [systolic >140 mm Hg], vomiting, agitation, seizure, myocardial infarction, arrhythmia, or pulmonary edema), and reversal of respiratory depression (respiratory rate >10 breaths/min and saturation >92% or Glasgow Coma Scale score 15).
RESULTS
From October 2019 to July 2021, there were 197 presentations in 171 patients, with a median age of 41 years (range, 18 to 80 years); of the total patients, 119 were men (70%). The most common opioids were heroin (131 [66%]), oxycodone (14 [7%]), and morphine (11 [6%]). Severe agitation occurred in 14 (7% [95% confidence interval {CI} 4% to 12%]) presentations. Opioid withdrawal occurred in 76 presentations (39% [95% CI 32% to 46%]), most commonly in the form of tachycardia (18%), mild agitation/anxiety (18%) and hypertension (14%). Three presentations (1.5%) received chemical sedation for severe agitation within 1 hour of naloxone administration. A single 1.6 mg dose of naloxone reversed respiratory depression in 192 (97% [95% CI: 94% to 99%]) presentations.
CONCLUSION
Severe agitation was uncommon following the administration of 1.6 mg IM naloxone and rarely required chemical sedation.
研究目的
大剂量肌肉内（IM）纳洛酮常用于院外环境以逆转阿片类药物毒性；然而，由于担心阿片类药物戒断，特别是激越，在医院中较少使用。我们旨在确定单次 1.6mgIM 纳洛酮给药后严重激越的频率。
方法
我们对澳大利亚州救护车服务治疗的成人（>15 岁）患者进行了一项前瞻性研究，这些患者因疑似阿片类药物中毒导致呼吸抑制（呼吸频率<11 次/分钟和/或室内空气氧饱和度<93%）接受了 1.6mgIM 纳洛酮治疗。主要结局是纳洛酮给药后 1 小时内出现严重激越（镇静评估工具评分>1）的表现比例。次要结局是出现急性阿片类药物戒断（心动过速[脉搏率>100 次/分钟]、高血压[收缩压>140mmHg]、呕吐、激越、癫痫发作、心肌梗死、心律失常或肺水肿）和呼吸抑制逆转（呼吸频率>10 次/分钟和饱和度>92%或格拉斯哥昏迷量表评分为 15）的表现比例。
结果
2019 年 10 月至 2021 年 7 月，共有 171 名患者的 197 次就诊，中位年龄为 41 岁（范围为 18 至 80 岁）；在所有患者中，119 名为男性（70%）。最常见的阿片类药物是海洛因（131 例[66%]）、羟考酮（14 例[7%]）和吗啡（11 例[6%]）。严重激越发生在 14 次就诊中（7%[95%置信区间{CI}4%至 12%]）。76 次就诊发生阿片类药物戒断（39%[95%CI32%至 46%]），最常见的形式是心动过速（18%）、轻度激越/焦虑（18%）和高血压（14%）。3 次就诊（1.5%）在纳洛酮给药后 1 小时内接受了化学镇静治疗严重激越。单次 1.6mg 剂量纳洛酮逆转了 192 次就诊中的呼吸抑制（97%[95%CI94%至 99%]）。
结论
给予 1.6mgIM 纳洛酮后，严重激越并不常见，很少需要化学镇静。
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