Beth Israel Deaconess Medical Center, New England Baptist Hospital, Boston, MA, USA.
Psychosomatics. 2010 Sep-Oct;51(5):409-18. doi: 10.1176/appi.psy.51.5.409.
Delirium is a serious postoperative condition for which few pharmacologic prevention trials have been conducted.
The authors tested the efficacy of perioperative olanzapine administration to prevent postoperative delirium in elderly patients after joint-replacement surgery.
The authors conducted a randomized, double-blind, placebo-controlled, prophylaxis trial at an orthopedic teaching hospital, enrolling 495 elderly patients age ≥65 years, who were undergoing elective knee- or hip-replacement surgery; 400 patients received either 5 mg of orally-disintegrating olanzapine or placebo just before and after surgery. The primary efficacy outcome was the incidence of (DSM-III-R) delirium.
The incidence of delirium was significantly lower in the olanzapine group than in the placebo group; this held true for both knee- and hip-replacement surgery. However, delirium lasted longer and was more severe in the olanzapine group. Advanced age, a high level of medical comorbidity, an abnormal albumin level, and having knee-replacement surgery were independent risk factors for postoperative delirium (Clinicaltrials.gov Identifier: NCT000699946).
Administration of 10 mg of oral olanzapine perioperatively, versus placebo, was associated with a significantly lower incidence of delirium. These findings suggest that olanzapine prophylaxis of postoperative delirium may be an effective strategy.
谵妄是一种严重的术后并发症，针对这种并发症的药物预防试验开展得很少。
作者检验了围手术期应用奥氮平预防老年患者人工关节置换术后谵妄的疗效。
作者在一家骨科教学医院开展了一项随机、双盲、安慰剂对照的预防性试验，纳入 495 名年龄≥65 岁、择期行膝关节或髋关节置换术的老年患者；其中 400 名患者在术前和术后分别给予 5mg 口服速溶奥氮平或安慰剂。主要疗效结局是（DSM-III-R）谵妄的发生率。
奥氮平组的谵妄发生率显著低于安慰剂组，在膝关节和髋关节置换术患者中均如此。然而，奥氮平组的谵妄持续时间更长且更严重。高龄、较高的医疗合并症水平、白蛋白水平异常和行膝关节置换术是术后谵妄的独立危险因素（Clinicaltrials.gov 标识符：NCT000699946）。
与安慰剂相比，围手术期给予 10mg 奥氮平可显著降低谵妄发生率。这些发现提示奥氮平预防术后谵妄可能是一种有效的策略。
