Kim Jisu, Kim Soo Hyun, Choi Seung Pill, Zhu Jong Ho, Kim Sung Wook, Kwon Mi Kyong, Oh Jae Hun
Department of Emergency, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea.
J Clin Med. 2025 Aug 24;14(17):5983. doi: 10.3390/jcm14175983.
Benzodiazepine poisoning is a frequent cause of emergency department (ED) visits, often related to suicide attempts. Flumazenil is the only specific antidote, but its continuous infusion protocol remains controversial because of its uncertain outcome benefits and increased risk of adverse events. This study aimed to evaluate the effect of continuous flumazenil infusion on the time to recovery of consciousness and secondary outcomes in patients with benzodiazepine poisoning stratified by hospitalization status. A retrospective cohort study was conducted at a tertiary hospital in Seoul, Korea, including adults treated for benzodiazepine poisoning in the ED between April 2019 and March 2024. The primary outcome being the time from arrival at the ED to regaining consciousness. Multivariate regression identified independent predictors of delayed recovery. Among the 370 patients, 52.4% were hospitalized. Flumazenil infusion was administered in 46.8% of the patients, more often in hospitalized patients. In this group, flumazenil infusion significantly reduced the median time to regain consciousness (13.7 vs. 19.4 h, = 0.006) but did not affect the overall hospital stay. In nonhospitalized patients, flumazenil infusion did not shorten the awakening time or prolong the ED stay. Adverse events, mainly agitation, were more frequent with flumazenil infusion. Continuous infusion of flumazenil accelerates the recovery of consciousness only in hospitalized patients who are severely affected by benzodiazepine poisoning but with increased adverse events and no reduction in hospital stay. Individualized patient selection and evidence-based protocols are needed for optimal and safe antidote use.
苯二氮䓬中毒是急诊科就诊的常见原因，常与自杀未遂有关。氟马西尼是唯一的特效解毒剂，但其持续输注方案仍存在争议，因为其疗效不确定且不良事件风险增加。本研究旨在评估持续输注氟马西尼对按住院状态分层的苯二氮䓬中毒患者意识恢复时间及次要结局的影响。在韩国首尔的一家三级医院进行了一项回顾性队列研究，纳入2019年4月至2024年3月期间在急诊科接受苯二氮䓬中毒治疗的成人患者。主要结局是从到达急诊科到恢复意识的时间。多变量回归分析确定了延迟恢复的独立预测因素。在370例患者中，52.4%住院治疗。46.8%的患者接受了氟马西尼输注，住院患者中输注更为常见。在这组患者中，氟马西尼输注显著缩短了恢复意识的中位时间（13.7小时对19.4小时，P = 0.006），但对总体住院时间无影响。在非住院患者中，氟马西尼输注未缩短苏醒时间或延长急诊科停留时间。不良事件主要为躁动，氟马西尼输注时更为常见。持续输注氟马西尼仅能加速受苯二氮䓬中毒严重影响的住院患者的意识恢复，但不良事件增加，且住院时间未缩短。为了最佳且安全地使用解毒剂，需要进行个体化患者选择并采用基于证据的方案。
