Department of Pharmacy, UMass Memorial Medical Center, Worcester, MA 01655, USA.
J Intensive Care Med. 2012 Nov-Dec;27(6):354-61. doi: 10.1177/0885066611403110. Epub 2011 Mar 25.
Delirium is commonly described in critically ill patients as 1 factor contributing to increased length of intensive care unit and hospital stay, secondary complications, and increased mortality. Initial screening tools for delirium in hospitalized patients are generally easy to use; however, many centers have struggled with implementing these tools in a consistent and systematic manner. Haloperidol has traditionally been prescribed as the primary agent of choice for the treatment of delirium in critically ill patients. Clinicians have been challenged to consider alternative agents due to adverse effects such as extrapyramidal symptoms, QTc prolongation, and possible torsades de pointes with haloperidol use. The atypical antipsychotics are attractive alternatives to haloperidol with improved safety profiles but are flawed by limited data to support dosing and efficacy in this patient population. Future studies that provide large, prospective, double-blinded, placebo-controlled data to support the implementation of these agents as standard therapy over haloperidol are needed.
谵妄通常被描述为危重症患者的一个因素，可导致 ICU 和住院时间延长、继发并发症增加和死亡率增加。用于住院患者谵妄的初始筛选工具通常易于使用；然而，许多中心在以一致和系统的方式实施这些工具方面遇到了困难。氟哌啶醇传统上被用作治疗危重症患者谵妄的首选药物。由于氟哌啶醇的不良反应，如锥体外系症状、QTc 延长和可能的尖端扭转型室性心动过速，临床医生一直在考虑替代药物。与氟哌啶醇相比，非典型抗精神病药具有更好的安全性，因此成为有吸引力的替代品，但由于缺乏支持在该患者人群中给药和疗效的有限数据，因此存在缺陷。需要进行未来的研究，提供大型、前瞻性、双盲、安慰剂对照的数据，以支持将这些药物作为标准治疗方案而不是氟哌啶醇的实施。
