大量回顾性队列的患者接受静脉注射奥氮平在急诊室。

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马特尔ML,克莱因LR,瑞瓦德RL,科尔简森-巴顿

大量回顾性队列的患者接受静脉注射奥氮平在急诊室。

阿德莱德大学地中海紧急情况。2016年1月;23 (1):29-35。doi: 10.1111 / acem.12842。Epub 2015年12月31日。

PubMed ID

26720055 (在PubMed

]

文摘

背景:奥氮平是一种非典型抗精神病药物与氟哌利多药理性质相似。由于当前氟哌利多不足,作者的临床实践已经在很多情况下用奥氮平代替氟哌利多。此时,奥氮平是美国食品和药物管理局批准用于口腔和肌内(IM)使用,但由于其效用增加,静脉注射(IV)奥氮平最近被批准用于研究急诊科(ED)。目的:作者试图审查的使用和安全四世奥氮平在ED患者人群。方法:回顾性审查之间的连续第四病人接受奥氮平1月1日2014年7月1日,2014年。数据是通过收集的电子医疗记录审核。这项研究被认为是免除知情同意由我们机构审查委员会。结果:共有713名患者接受静脉奥氮平在研究期间。的平均年龄是38年(范围= 18到85岁)和313例男性(43.9%)。主要适应症IV奥氮平管理包括急性风潮(n = 245, 34.4%),腹痛(n = 165, 23.1%)、头痛(n = 121, 17.0%),恶心和呕吐(n = 107, 15.0%)、疼痛(其他; n = 60, 8.4%), and unknown (n = 15, 2.1%). IV dosing varied: 1.25 mg (n = 20, 2.8%), 2.5 mg (n = 185, 25.9%), 5 mg (n = 507, 71.1%), and 10 mg (n = 1, 0.1%). Forty-nine patients required a second dose of olanzapine (22 IV, 26 IM, one oral). The maximum total dose of olanzapine was 20 mg. Ninety-eight patients required a total of 146 doses of additional sedatives during their ED course. Other sedative medications included ketamine (n = 17, 2.4%), haloperidol (n = 48, 6.7%), and benzodiazepines (n = 81, 11.4%). Hypoxia was noted in 74 patients (10.4%). Major respiratory complications, including airway stimulation or repositioning maneuvers and intubation, occurred in 15 patients (2.1%). After consensus review, one intubation was classified as "likely related" to olanzapine administration, and two were classified as "possibly related" to olanzapine. Akathisia likely occurred in four patients (0.6%), and no allergic reactions were identified. Electrocardiograms (ECGs) were performed in 322 patients. A total of 251 patients had an ECG performed before olanzapine administration (median QTc = 404 ms), and 88 patients had an ECG performed after olanzapine administration (median QTc = 415 ms). Acute alcohol and drug intoxication was common, 118 (16.5%) patients were positive for ethanol, and seven of 23 drug screens were positive for sympathomimetics. Thirty-four of 284 admissions (4.5%) were to intermediate or intensive care unit beds. No patients died while in the ED and no cases of sudden cardiac death were noted. CONCLUSIONS: In this large retrospective review, IV olanzapine appears to be a safe in the management of a variety of ED indications. Hypoxia was common, but serious airway compromise was rare.

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药物

奥氮平