Department of Palliative Care & Rehabilitation Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
J Pain Symptom Manage. 2010 Feb;39(2):186-96. doi: 10.1016/j.jpainsymman.2009.07.009.
Neuroleptics are commonly used in the management of delirium. Limited information is available regarding the dosage requirements and efficacy of neuroleptics in the palliative care setting. We determined the type and dose of neuroleptic use by delirium subtype. The medical records of 99 inpatients with advanced cancer were reviewed retrospectively. The doses of different neuroleptics, expressed as haloperidol equivalent daily doses (HEDDs), were correlated with delirium recall, recalled delirium symptom frequency, and associated distress from the patients', family caregivers', nurses' and palliative care specialists' perspectives. Subtypes of delirium included hypoactive in 20 (20%), mixed in 66 (67%), and hyperactive in 13 (13%). The median HEDD was 2.5mg, interquartile range (Q1-Q3) 1-4.7 mg (mean 4.0+/-5.9 mg), and it was significantly higher in agitated and mixed delirium as compared with hypoactive delirium (P=0.008). The neuroleptic dose was low and appeared to be ineffective in preventing patient delirium recall, with 73 (74%) patients remembering their episode of delirium as distressing. HEDD did not correlate with delirium recall, recalled symptom frequency, or distress for patients and family caregivers. However, HEDD increased with nurses' distress related to patients' symptoms (disorientation to place P=0.002, disorientation to time P=0.008, delusions P=0.041, and agitation P<0.001), and palliative care specialists' distress related to patients' hallucinatory symptoms (P=0.006) and agitation (P=0.006). In this study, the administered neuroleptic dose was influenced more by health care professional distress than by delirium symptom frequency. Future studies should examine the efficacy of neuroleptic dose according to individual delirium symptoms.
神经阻滞剂常用于谵妄的治疗。在姑息治疗环境中，关于神经阻滞剂的剂量要求和疗效的信息有限。我们根据谵妄亚型确定了神经阻滞剂的类型和剂量。回顾性分析了 99 例晚期癌症住院患者的病历。不同神经阻滞剂的剂量，以氟哌啶醇等效日剂量（HEDD）表示，与谵妄回忆、回忆性谵妄症状频率以及患者、家属照顾者、护士和姑息治疗专家的相关痛苦相关。谵妄的亚型包括低活动型 20 例（20%）、混合型 66 例（67%）和高活动型 13 例（13%）。HEDD 的中位数为 2.5mg，四分位间距（Q1-Q3）为 1-4.7mg（平均 4.0+/-5.9mg），与低活动型谵妄相比，躁动型和混合型谵妄的 HEDD 显著升高（P=0.008）。神经阻滞剂的剂量较低，似乎无法有效预防患者的谵妄回忆，73%（74%）的患者回忆起自己的谵妄发作时感到痛苦。HEDD 与患者和家属照顾者的谵妄回忆、回忆性症状频率或痛苦无关。然而，HEDD 随着与患者症状相关的护士痛苦而增加（地点定向障碍 P=0.002，时间定向障碍 P=0.008，妄想 P=0.041，躁动 P<0.001），以及与患者幻觉症状（P=0.006）和躁动（P=0.006）相关的姑息治疗专家的痛苦而增加。在这项研究中，给予的神经阻滞剂剂量受医护人员痛苦的影响大于受谵妄症状频率的影响。未来的研究应该根据个体的谵妄症状来检查神经阻滞剂剂量的疗效。
