急性紊乱是一个广义的术语,指的是精神状态改变后的行为升级,如激动,侵略,和暴力。可用的管理选项包括降级技术和快速镇静,主要是通过肠胃外制剂的药物。虽然肌内途径已经在一系列临床环境中得到了广泛的研究,静脉注射(IV)不能说同样的话;尽管有潜在的好处,包括快速吸收和完全生物利用度。本系统评价分析了静脉给药治疗急性紊乱的有效性和安全性的现有证据。它遵循预先注册的协议(PROSPERO鉴定CRD42020216456),并遵循系统审查和荟萃分析(PRISMA)的首选报告项目设定的指南进行报告。APAPsycINFO,MEDLINE,和EMBASE数据库在2023年5月30日之前搜索合格的介入研究。由于主要结果指标差异很大,因此数据分析仅限于叙事综合。结果显示静脉注射右美托咪定的效果混合但呈阳性,劳拉西泮,氟哌利多,还有奥氮平.静脉注射氟哌啶醇的证据比较有限,氯胺酮,咪达唑仑,氯丙嗪,和丙戊酸盐。没有关于使用静脉注射氯硝西泮的合格数据,可乐定,地西泮,苯海拉明,普萘洛尔,齐拉西酮,氟奋乃静,卡马西平,或者异丙嗪.大多数研究报告了有利的不良事件概况,尽管它们不太可能有足够的动力来处理罕见的严重事件。在大多数情况下,证据质量低或混合,强调需要进一步标准化,大规模,具有同质结局指标的多臂随机对照试验。总的来说,这篇综述表明,静脉给药可能为急性紊乱提供另一种有效的肠胃外给药途径。特别是在一般医院设置。
Acute disturbance is a broad term referring to escalating behaviors secondary to a change in mental state, such as agitation, aggression, and violence. Available management options include de-escalation techniques and rapid tranquilization, mostly via parenteral formulations of medication. While the intramuscular route has been extensively studied in a range of clinical settings, the same cannot be said for
intravenous (IV); this is despite potential benefits, including rapid absorption and complete bioavailability. This systematic
review analyzed existing evidence for effectiveness and safety of IV medication for management of acute disturbances. It followed a preregistered protocol (PROSPERO identification CRD42020216456) and is reported following the guidelines set by Preferred Reporting Items for Systematic
Review and Meta-Analysis. APA PsycINFO, MEDLINE, and EMBASE databases were searched for eligible interventional studies up until May 30th, 2023. Data analysis was limited to narrative synthesis since primary outcome measures varied significantly. Results showed mixed but positive results for the effectiveness of IV dexmedetomidine, lorazepam, droperidol, and olanzapine. Evidence was more limited for IV haloperidol, ketamine, midazolam, chlorpromazine, and valproate. There was no eligible data on the use of IV clonazepam, clonidine, diazepam, diphenhydramine, propranolol, ziprasidone, fluphenazine, carbamazepine, or promethazine. Most studies reported favorable adverse event profiles, though they are unlikely to have been sufficiently powered to pick up rare serious events. In most cases, evidence was of low or mixed quality, accentuating the need for further standardized, large-scale, multi-arm randomized controlled trials with homogeneous outcome measures. Overall, this
review suggests that IV medications may offer an effective alternative parenteral route of administration in acute disturbance, particularly in general hospital settings.