喹硫平对伴有谵妄的重症患者谵妄症状消退的影响：一项双盲、随机、安慰剂对照研究的事后分析。
Impact of quetiapine on resolution of individual delirium symptoms in critically ill patients with delirium: a post-hoc analysis of a double-blind, randomized, placebo-controlled study.
机构信息
Northeastern University School of Pharmacy, 360 Huntington Avenue, Mugar 206, Boston, MA 02115, USA.
出版信息
Crit Care. 2011;15(5):R215. doi: 10.1186/cc10450. Epub 2011 Sep 17.
INTRODUCTION
We hypothesized that delirium symptoms may respond differently to antipsychotic therapy. The purpose of this paper was to retrospectively compare duration and time to first resolution of individual delirium symptoms from the database of a randomized, double-blind, placebo-controlled study comparing quetiapine (Q) or placebo (P), both with haloperidol rescue, for critically ill patients with delirium.
METHODS
Data for 10 delirium symptoms from the eight-domain, intensive care delirium screening checklist (ICDSC) previously collected every 12 hours were extracted for 29 study patients. Data between the Q and P groups were compared using a cut-off P-value of ≤ 0.10 for this exploratory study.
RESULTS
Baseline ICDSC scores (5 (4 to 7) (Q) vs 5 (4 to 6)) (median, interquartile range (IQR)) and % of patients with each ICDSC symptom were similar in the two groups (all P > 0.10). Among patients with the delirium symptom at baseline, use of Q may lead to a shorter time (days) to first resolution of symptom fluctuation (4 (Q) vs. 14, P = 0.004), inattention (3 vs. 8, P = .10) and disorientation (2 vs. 10, P = 0.10) but a longer time to first resolution of agitation (3 vs. 1, P = 0.04) and hyperactivity (5 vs. 1, P = 0.07). Among all patients, Q-treated patients tended to spend a smaller percent of time with inattention (47 (0 to 67) vs. 78 (43 to 100), P = 0.025), hallucinations (0 (0 to 17) vs. 28 (0 to 43), P = 0.10) and symptom fluctuation (47 (19 to 67) vs. 89 (33 to 00), P = 0.04] and there was a trend for Q-treated patients to spend a greater percent of time at an appropriate level of consciousness (26% (13 to 63%) vs. 14% (0 to 33%), P = 0.17].
CONCLUSIONS
Our exploratory analysis suggests that quetiapine may resolve several intensive care unit (ICU) delirium symptoms faster than the placebo. Individual symptom resolution appears to differ in association with the pharmacologic intervention (that is, P vs Q, both with as needed haloperidol). Future studies evaluating antipsychotics in ICU patients with delirium should measure duration and resolution of individual delirium symptoms and their relation to long-term outcomes.
简介
我们假设谵妄症状可能对抗精神病药物治疗有不同的反应。本文的目的是回顾性比较接受喹硫平（Q）或安慰剂（P）治疗的危重症谵妄患者数据库中，每个谵妄症状的持续时间和首次缓解时间，这些患者均接受了齐拉西酮和氟哌啶醇的随机、双盲、安慰剂对照研究。
方法
从之前每 12 小时采集的 8 域重症监护谵妄筛查检查表（ICDSC）中提取了 10 种谵妄症状的数据，这些数据来自 29 名研究患者。使用 ≤0.10 的截止 P 值对 Q 组和 P 组的数据进行比较，进行这项探索性研究。
结果
两组患者的基线 ICDSC 评分（5（4 至 7）（Q）与 5（4 至 6）（中位数，四分位距（IQR）））和每个 ICDSC 症状的患者百分比相似（均 P＞0.10）。在基线时有谵妄症状的患者中，使用 Q 可能会导致症状波动（4（Q）与 14，P=0.004）、注意力不集中（3 与 8，P=0.10）和定向障碍（2 与 10，P=0.10）的首次缓解时间缩短，但激越（3 与 1，P=0.04）和多动（5 与 1，P=0.07）的首次缓解时间延长。在所有患者中，Q 治疗组的注意力不集中（47（0 至 67）与 78（43 至 100），P=0.025）、幻觉（0（0 至 17）与 28（0 至 43），P=0.10）和症状波动（47（19 至 67）与 89（33 至 00）的时间百分比较小，并且 Q 治疗组处于适当意识水平的时间百分比有增加趋势（26%（13 至 63%）与 14%（0 至 33%），P=0.17）。
结论
我们的探索性分析表明，喹硫平可能比安慰剂更快地缓解几种 ICU 谵妄症状。单个症状的缓解似乎与药物干预有关（即 Q 与 P，均按需使用氟哌啶醇）。未来评估 ICU 谵妄患者使用抗精神病药物的研究应测量每个谵妄症状的持续时间和缓解时间及其与长期结局的关系。
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