离散性发作在急诊室:改善的空间
Ozan Cengiz1, Johannes Jungilligens1, Rosa Michaelis1
1Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany.
Journal of neurology, neurosurgery, and psychiatry
|September 27, 2023
概括
在紧急情况下,分离性发作往往被误诊为. 改进的临床评估可以提高诊断,但二二类药物的使用显示混合的结果和风险不良影响.
科学领域:
- 神经学 神经学
- 紧急医疗 紧急医疗
- 精神病学是一个精神病学.
背景情况:
- 分离性发作 (DS),也称为功能性或精神性非发作 (PNES),占紧急发作病例的很大一部分 (11%-27%).
- 误诊的DS作为发作是频繁的,导致不适当的和潜在的有害的治疗升级.
研究的目的:
- 评估在离散性发作的各种紧急工作阶段的诊断改进.
- 评估在患有分离性发作的患者中使用二zepine的有效性和安全性.
主要方法:
- 在一所大学医院 (2010-2022) 进行急诊诊断急性分离性的紧急情况的回顾性分析.
- 临床特征,紧急决策和诊断准确性的评估由现场紧急医生与急诊部神经科医生对比.
主要成果:
- 从现场急诊医生 (12%) 到急诊部神经科医生 (52%) 的诊断准确度显著提高.
- 三分之二的持续发作中使用了二,临床反应各异,包括关键镇静 (13%) 和缺乏效果 (16%).
- 接受二类药物治疗的显著比例的患者需要密集监测 (25%) 或输管 (9%).
结论:
- 增强的半学评估对于减少分离性的早期误诊至关重要.
- 虽然一些离散性发作可能对二类药物有反应,但危险的临界镇静需要进一步研究它们的治疗比率.
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