《急诊科急性行为障碍管理指南（第3版）》解读

doi:10.3761/j.issn.2096-7446.2026.09.009

摘要/Abstract

摘要：

2025年5月英国皇家急诊医学院（Royal College of Emergency Medicine，RCEM）发布了《急诊科急性行为障碍管理指南（第3版）》，这是国际急诊领域关于急性行为障碍（acute behavioural disturbance，ABD）管理的最新循证实践指南。该指南强调急性行为障碍为一种伴有异常生理改变的急性精神运动性兴奋状态，涵盖急性行为障碍的识别与定义、安全风险评估、语言与环境降级、镇静药物选择、复苏与监测、物理约束原则及特殊人群管理等内容。该文对该指南修订背景、核心推荐及药物选择进行解读，并探讨其在中国临床环境下的适用性，以期为中国急诊科急性行为障碍患者的规范化、安全化管理提供参考。

关键词: 急诊科, 急性行为障碍, 英国皇家急诊医学院, 指南, 解读

Abstract:

In May 2025，the Royal College of Emergency Medicine（RCEM） released the Guideline for the Management of Acute Behavioural Disturbance in the Emergency Department（Third Edition），representing the latest evidence-based practice guidance on the management of acute behavioural disturbance（ABD） in the international emergency medicine field. The guideline characterizes ABD as a state of acute psychomotor agitation accompanied by abnormal physiological changes. It covers key aspects including the identification and definition of ABD，safety risk assessment，verbal and environmental de-escalation，selection of sedative agents，resuscitation and monitoring，principles of physical restraint，and management considerations for special populations. This article provides an interpretation of the revision background，core recommendations，and pharmacological options of the guideline，and discusses its applicability within the Chinese clinical environment，aiming to provide a reference for the standardized and safe management of patients with ABD in emergency departments in China.

Key words: Emergency Department, Acute Behavioural Disturbance, Royal College of Emergency Medicine, Guideline, Interpretation

曹渝龙, 高燕, 甘秀妮. 《急诊科急性行为障碍管理指南（第3版）》解读[J]. 中华急危重症护理杂志, 2026, 7(9): 1089-1095.

CAO Yulong, GAO Yan, GAN Xiuni. Interpretation of Guidelines for the Management of Acute Behavioural Disturbance in the Emergency Department（3rd Edition）[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(9): 1089-1095.

图/表 3

参考文献 31

[1]	Stevenson R, Tracy DK. Acute behavioural disturbance:a physical emergency psychiatrists need to understand[J]. Bjpsych Adv, 2021, 27(5):333-342. doi: 10.1192/bja.2020.67
[2]	Holloman G, Zeller S. Overview of project BETA:best practices in evaluation and treatment of agitation[J]. WestJEM, 2012, 13(1):1-2. doi: 10.5811/westjem.2011.9.6865
[3]	Yap CYL, Taylor DM, Kong DCM, et al. Risk factors for sedation-related events during acute agitation management in the emergency department[J]. Acad Emerg Med, 2019, 26(10):1135-1143. doi: 10.1111/acem.13826 pmid: 31265756
[4]	Zoleo M, Della Rocca F, Tedeschi F, et al. Violence against health workers:findings from three emergency departments in the teaching hospital of Padua,Italy[J]. Intern Emerg Med, 2020, 15(6):1067-1074. doi: 10.1007/s11739-020-02290-7
[5]	Lei ZH, Yan SJ, Jiang H, et al. Prevalence and risk factors of workplace violence against emergency department nurses in China[J]. Int J Public Health, 2022, 67:1604912. doi: 10.3389/ijph.2022.1604912
[6]	中华医学会精神医学分会精神分裂症协作组. 激越患者精神科处置专家共识[J]. 中华精神科杂志, 2017, 50(6):401-410.
	Chinese Society of Psychiatry,Schizophrenia Coordination Group. Expert consensus on psychiatric treatment of agitation patients[J]. Chin J Psychiatry, 2017, 50(6):401-410.
[7]	中华医学会急诊医学分会危重症学组, 中国急诊成人镇痛、镇静与谵妄管理专家共识组. 中国急诊成人镇痛、镇静与谵妄管理专家共识[J]. 中华急诊医学杂志, 2023, 32(12):1594-1609.
	Critical Care Group of Chinese Emergency Medicine Society; Expert Consensus Group on Adult Analgesia, Sedation and Delir-ium Management in Chinese Emergency Department. Expert consensus on adult analgesia,sedation and delirium management in Chinese emergency departments[J]. Chin J Emerg Med, 2023, 32(12):1594-1609.
[8]	Royal College of Emergency Medicine. Acute behavioural disturbance in emergency departments:best practice guideline,version 3[EB/OL]. London:Royal College of Emergency Medicine,2025[2026-05-27]. https://www.rcem.ac.uk/publications-guidelines/best-practice-guidelines/acute-behavioural-disturbance-in-emer-gency-departments-version-3-may-2025/.
[9]	Humphries C, Kelly A, Sadik A, et al. Consensus on acute behavioural disturbance in the UK:a multidisciplinary modified Delphi study to determine what it is and how it should be managed[J]. Emerg Med J, 2024, 41(1):4-12. doi: 10.1136/emermed-2023-213335
[10]	Gonin P, Beysard N, Yersin B, et al. Excited delirium:a syste-matic review[J]. Acad Emerg Med, 2018, 25(5):552-565. doi: 10.1111/acem.2018.25.issue-5
[11]	Liu F, Chen JJ, Du Y, et al. Misidentification of acute psychiatric symptoms in the emergency room:clinical experience in China[J]. Front Psychiatry, 2021, 11:579484. doi: 10.3389/fpsyt.2020.579484
[12]	Casey CA, Guzman J, Salard M, et al. Refining medical clearance protocol for patients with primary psychiatric complaints in the emergency department[J]. Front Psychiatry, 2023, 14:1209450. doi: 10.3389/fpsyt.2023.1209450
[13]	Weedn V, Steinberg A, Speth P. Prone restraint cardiac arrest in in-custody and arrest-related deaths[J]. J Forensic Sci, 2022, 67(5):1899-1914. doi: 10.1111/1556-4029.15101 pmid: 35869602
[14]	Zhu SN, Liu J, Cao AL, et al. Study of psychomotor agitation constraint method:a systematic review[J]. Actas Esp Psiquiatr, 2025, 53(3):598-604. doi: 10.62641/aep.v53i3.1997
[15]	Cui NQ, Zhang H, Gan SJ, et al. Prevalence and influencing factors of physical restraints in intensive care units:a retrospective cohort study[J]. Risk Manag Healthc Policy, 2023, 16:945-956. doi: 10.2147/RMHP.S408919
[16]	Zhang CC, Liu D, He QF. The characteristics of ICU physical restraint use and related influencing factors in China:a multi-center study[J]. Ann Palliat Med, 2021, 10(2):1198-1206. doi: 10.21037/apm
[17]	Cui NQ, Qiu RL, Zhang YP, et al. Why are physical restraints still in use? A qualitative descriptive study from Chinese critical care clinicians’ perspectives[J]. BMJ Open, 2021, 11(11):e055073. doi: 10.1136/bmjopen-2021-055073
[18]	法律出版社法规中心. 中华人民共和国精神卫生法:注释本[M]. 北京: 法律出版社, 2012.
	Statutory Research Center, Law Press. Mental Health Law of the People’s Republic of China:Annotated Version[M]. Beijing: Law Press, 2012.
[19]	Ye JR, Xiao AX, Yu L, et al. Physical restraints:an ethical dilemma in mental health services in China[J]. Int J Nurs Sci, 2018, 5(1):68-71.
[20]	蒲秋霞, 李红伟, 李虹静, 等. 从破窗理论谈急诊科工作场所暴力的防范[J]. 中华急危重症护理杂志, 2020, 1(2):186-189.
	Pu QX, Li HW, Li HJ, et al. Prevention of workplace violence in broken window theory altar emergency department[J]. Chin J Emerg Crit Care Nurs, 2020, 1(2):186-189.
[21]	Richmond J, Berlin J, Fishkind A, et al. Verbal de-escalation of the agitated patient:consensus statement of the American Association for Emergency Psychiatry Project BETA de-escalation workgroup[J]. WestJEM, 2012, 13(1):17-25. doi: 10.5811/westjem.2011.9.6864
[22]	Chen X, Zeng YT, Jiang L, et al. Assessing emergency department nurses’ ability to communicate with angry patients and the factors that influence it[J]. Front Public Health, 2023, 11:1098803. doi: 10.3389/fpubh.2023.1098803
[23]	周春清, 冯欣夷, 马小琴. 护理专业学生预防与应对工作场所暴力培训实践的范围综述[J]. 中华急危重症护理杂志, 2024, 5(9):818-824.
	Zhou CQ, Feng XY, Ma XQ. Training practices for nursing students to prevent and respond to workplace violence:a scoping review[J]. Chin J Emerg Crit Care Nurs, 2024, 5(9):818-824.
[24]	Zeng X, Zou C, Tao HX, et al. Workplace violence against primary care physicians in Chengdu,China:a cross-sectional survey[J]. J Prim Care Community Health, 2025, 16:21501319251318837.
[25]	Ye JR, Xia ZC, Wang C, et al. Effectiveness of CRSCE-based de-escalation training on reducing physical restraint in psy-chiatric hospitals:a cluster randomized controlled trial[J]. Front Psychiatry, 2021, 12:576662. doi: 10.3389/fpsyt.2021.576662
[26]	吴莹玉, 黄霞, 贾培培, 等. 护士工作场所暴力防范培训体系的构建[J]. 中华护理杂志, 2020, 55(4):584-589. doi: 10.3761/j.issn.0254-1769.2020.04.020
	Wu YY, Huang X, Jia PP, et al. Development of a nurse training indicator system against workplace violence based on behavioral objectives theory[J]. Chin J Nurs, 2020, 55(4):584-589. doi: 10.3761/j.issn.0254-1769.2020.04.020
[27]	Cole JB, Lee SC, Martel ML, et al. The incidence of QT prolongation and torsades des pointes in patients receiving droperidol in an urban emergency department[J]. West J Emerg Med, 2020, 21(4):728-736. doi: 10.5811/westjem.2020.4.47036 pmid: 32726229
[28]	Alshehri AM, Crowley KE, Lupi KE, et al. Evaluation of droperidol use in the emergency department:a retrospective analysis of QTc prolongation and adverse events[J]. BMC Emerg Med, 2024, 24(1):232. doi: 10.1186/s12873-024-01158-9
[29]	急诊呼气末二氧化碳监测专家共识组. 急诊呼气末二氧化碳监测专家共识[J]. 中华急诊医学杂志, 2017, 26(5):507-511.
	Emergency end-tidal carbon dioxide monitoring expert consensus group. Expert consensus on emergency end-expiratory carbon dioxide monitoring[J]. Chin J Emerg Med, 2017, 26(5):507-511.
[30]	Chen F, Liu LB, Wang YT, et al. Delirium prevalence in geriatric emergency department patients:a systematic review and meta-analysis[J]. Am J Emerg Med, 2022, 59:121-128. doi: 10.1016/j.ajem.2022.05.058 pmid: 35841845
[31]	Zhou JY, Qin QZ, Chen SG, et al. Moral dilemmas regarding physical restraints in intensive care units:understanding autonomy,beneficence,non-maleficence and justice in the use of physical restraints[J]. J Multidiscip Healthc, 2024, 17:1619-1627. doi: 10.2147/JMDH.S455910