Dunhill Medical Trust Research Fellow, Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford BD9 6RJ, UK.
Age Ageing. 2011 Jan;40(1):23-9. doi: 10.1093/ageing/afq140. Epub 2010 Nov 9.
delirium is a common clinical problem and is associated with adverse health outcomes. Many medications have been associated with the development of delirium, but the strength of the associations is uncertain and it is unclear which medications should be avoided in people at risk of delirium.
we conducted a systematic review to identify prospective studies that investigated the association between medications and risk of delirium. A sensitivity analysis was performed to construct an evidence hierarchy for the risk of delirium with individual agents.
a total of 18,767 studies were identified by the search strategy. Fourteen studies met the inclusion criteria. Delirium risk appears to be increased with opioids (odds ratio [OR] 2.5, 95% CI 1.2-5.2), benzodiazepines (3.0, 1.3-6.8), dihydropyridines (2.4, 1.0-5.8) and possibly antihistamines (1.8, 0.7-4.5). There appears to be no increased risk with neuroleptics (0.9, 0.6-1.3) or digoxin (0.5, 0.3-0.9). There is uncertainty regarding H(2) antagonists, tricyclic antidepressants, antiparkinson medications, steroids, non-steroidal anti-inflammatory drugs and antimuscarinics.
for people at risk of delirium, avoid new prescriptions of benzodiazepines or consider reducing or stopping these medications where possible. Opioids should be prescribed with caution in people at risk of delirium, but this should be tempered by the observation that untreated severe pain can itself trigger delirium. Caution is also required when prescribing dihydropyridines and antihistamine H1 antagonists for people at risk of delirium and considered individual patient assessment is advocated.
谵妄是一种常见的临床问题，与不良健康结局相关。许多药物与谵妄的发生有关，但关联的强度不确定，也不清楚在谵妄风险人群中应避免使用哪些药物。
我们进行了一项系统评价，以确定前瞻性研究，调查药物与谵妄风险之间的关系。进行了敏感性分析，以构建个体药物引起谵妄风险的证据等级。
通过搜索策略共确定了 18767 项研究。有 14 项研究符合纳入标准。阿片类药物（比值比 [OR] 2.5，95%可信区间 [CI] 1.2-5.2）、苯二氮䓬类药物（OR 3.0，1.3-6.8）、二氢吡啶类药物（OR 2.4，1.0-5.8）和可能的抗组胺药（OR 1.8，0.7-4.5）似乎会增加谵妄风险。神经安定药（OR 0.9，0.6-1.3）或地高辛（OR 0.5，0.3-0.9）似乎没有增加风险。对于 H2 拮抗剂、三环类抗抑郁药、抗帕金森病药物、皮质类固醇、非甾体抗炎药和抗毒蕈碱类药物，存在不确定性。
对于谵妄风险人群，避免新处方开苯二氮䓬类药物或尽可能减少或停止这些药物。对于谵妄风险人群，应谨慎开阿片类药物，但应注意未治疗的严重疼痛本身可引发谵妄。对于有谵妄风险的人群，开二氢吡啶类药物和组胺 H1 拮抗剂时也需谨慎，提倡个体化患者评估。
