Liptzin Benjamin, Laki Agnes, Garb Jane L, Fingeroth Richard, Krushell Robert
Department of Psychiatry, Baystate Medical Center, 759 Chestnut Street (S1581), Springfield, MA 01199, USA.
Am J Geriatr Psychiatry. 2005 Dec;13(12):1100-6. doi: 10.1176/appi.ajgp.13.12.1100.
Delirium is a frequent complication of major surgery in older persons. The authors evaluated the possible benefit of donepezil versus placebo in the prevention and treatment of postoperative delirium in an older population without dementia undergoing elective total joint-replacement surgery.
A sample of 80 patients participated in this randomized, double-blind, placebo-controlled trial of donepezil. Each participant was evaluated before surgery and then received donepezil or placebo for 14 days before surgery and 14 days afterward. Postoperative delirium was assessed with the Delirium Symptom Interview, Confusion Assessment Method, daily medical record, nurse-observation reviews, and DSM-IV diagnostic criteria for delirium. Subsyndromal delirium was also assessed for each participant.
Delirium, diagnosed by DSM-IV criteria, was found on at least 1 postoperative day in 18.8% of subjects, but there were no significant differences between the donepezil and placebo groups. When delirium was present, it lasted only 1 day, and there was no difference between the groups. Subsyndromal delirium was found on at least 1 postoperative day for 68.8% of subjects, and, when this occurred, lasted 2 days or less, on average. There was no difference between the groups in the occurrence or duration of subsyndromal delirium. There was no difference between the groups in disposition to home or to another facility.
This pilot study was unable to demonstrate a benefit for donepezil in preventing or treating delirium in a relatively young and cognitively-intact group of elderly patients undergoing elective orthopedic surgery. Furthermore, postoperative delirium was not a major problem in this population.
谵妄是老年人进行大手术时常见的并发症。作者评估了多奈哌齐与安慰剂相比，在预防和治疗接受择期全关节置换手术、无痴呆的老年人群术后谵妄方面可能具有的益处。
80名患者参与了这项多奈哌齐的随机、双盲、安慰剂对照试验。每位参与者在手术前接受评估，然后在手术前14天和术后14天接受多奈哌齐或安慰剂治疗。术后谵妄通过谵妄症状访谈、意识模糊评估方法、每日病历、护士观察记录以及谵妄的DSM-IV诊断标准进行评估。还对每位参与者的亚综合征性谵妄进行了评估。
根据DSM-IV标准诊断，18.8%的受试者在术后至少1天出现谵妄，但多奈哌齐组和安慰剂组之间无显著差异。出现谵妄时，仅持续1天，两组之间无差异。68.8%的受试者在术后至少1天出现亚综合征性谵妄，出现时平均持续2天或更短时间。亚综合征性谵妄的发生率和持续时间在两组之间无差异。两组在回家或转至其他机构的情况方面无差异。
这项初步研究未能证明多奈哌齐在预防或治疗接受择期骨科手术、相对年轻且认知功能完好的老年患者谵妄方面具有益处。此外，术后谵妄在该人群中并非主要问题。
