肌注咪达唑仑、苯海拉明和氟哌啶醇在精神科急诊科急性躁动管理中的应用

IF 2.8 3区 医学 Q2 PHARMACOLOGY & PHARMACY
Andrew M Williams, Rachel Mong, Kuniko Chijiwa, Alaa Alabadi-Bierman, Brandon Q Tran, Phillip Huynh, Teressa Benbarka, Timothy Allison-Aipa
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引用次数: 0

摘要

摘要:背景:劳拉西泮肌注用于急性激动患者。在劳拉西泮短缺期间,咪达唑仑被选为本研究地点的首选IM苯二氮卓类药物。本研究旨在探讨氟哌啶醇、苯海拉明和咪达唑仑治疗急性激动患者的疗效和安全性。方法:对在精神科急诊科(ED)接受IM苯海拉明和氟哌啶醇联合咪达唑仑(咪达唑仑+)或劳拉西泮(劳拉西泮+)治疗的2例劳拉西泮短缺期成年患者进行单中心、回顾性图表回顾。采用多变量普通最小二乘法和logistic回归分析来评估IM后患者的行为活动评定量表(BARS)评分以及IM给药的安全性和耐受性。结果:174例患者符合纳入标准,其中咪达唑仑+组(治疗组)87例,劳拉西泮+组(对照组)87例。劳拉西泮+患者的BARS评分比咪达唑仑+患者降低9.4% (P)。结论:这是第一个研究咪达唑仑与氟哌啶醇和苯海拉明联合肌注的研究。咪达唑仑+在控制躁动方面是有效的,可能是劳拉西泮+的替代品。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Use of Intramuscular Midazolam, Diphenhydramine, and Haloperidol in Acute Agitation Management in a Psychiatric Emergency Department.

Abstract:

Background: Intramuscular (IM) lorazepam is administered to acutely agitated patients. During a lorazepam shortage, midazolam was selected as the IM benzodiazepine of choice at this study location. This study aims to explore the efficacy and safety of IM haloperidol, diphenhydramine, and midazolam in treating acutely agitated patients.

Methods: A single center, retrospective chart review was conducted in adult patients who received IM diphenhydramine and haloperidol in combination with either midazolam (midazolam+) or lorazepam (lorazepam+) in a psychiatric emergency department (ED) during 2 identified lorazepam shortage periods. Multivariate ordinary least squares and logistic regression analyses were used to evaluate post-IM patients' conditions in behavioral activity rating scale (BARS) scores and the safety and tolerability of IM administrations.

Results: A total of 174 patients met inclusion criteria, with 87 patients in the midazolam+ group (treatment) and 87 patients in the lorazepam+ group (control). Lorazepam+ was associated with a 9.4% greater decrease in BARS score than midazolam+ ( P <0.01). Midazolam+ administrations achieved a goal BARS score of 4 more frequently than lorazepam+ ( P <0.05). 18.4% more patients received a BARS score of 2, oversedation with lorazepam+ ( P <0.05). Lorazepam+ patients took nearly 3 hours (176 min) longer than midazolam+ to return to "normal" baseline behavior ( P <0.001). No statistically significant differences were detected in the incidence of hypotensive episodes or oxygen desaturation between groups.

Conclusions: This is the first study to examine coadministration of intramuscular midazolam with haloperidol and diphenhydramine. Midazolam+ was effective at managing agitation and may be an alternative to lorazepam+.

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来源期刊
CiteScore
4.00
自引率
3.40%
发文量
231
审稿时长
4-8 weeks
期刊介绍: Journal of Clinical Psychopharmacology, a leading publication in psychopharmacology, offers a wide range of articles reporting on clinical trials and studies, side effects, drug interactions, overdose management, pharmacogenetics, pharmacokinetics, and psychiatric effects of non-psychiatric drugs. The journal keeps clinician-scientists and trainees up-to-date on the latest clinical developments in psychopharmacologic agents, presenting the extensive coverage needed to keep up with every development in this fast-growing field.
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