Critical Care, College of Pharmacy, Western New England University, Springfield, MA, USA.
Ann Pharmacother. 2013 Jun;47(6):869-76. doi: 10.1345/aph.1AR708.
To review recent clinical studies regarding the role of dexmedetomidine for prevention and treatment of delirium in intensive care unit (ICU) patients.
MEDLINE and PubMed searches (1988-Feburary 2013) were conducted, using the key words delirium, dexmedetomidine, Precedex, agitation, α-2 agonists, critical care, and intensive care. References from relevant articles were reviewed for additional information.
Clinical trials comparing dexmedetomidine with other sedatives/analgesics or with antipsychotics for delirium were selected. Studies that evaluated the use of dexmedetomidine for sedation for more than 6 hours were included in this review.
Dexmedetomidine is a highly selective α-2 receptor agonist that provides sedation, anxiolysis, and modest analgesia with minimal respiratory depression. Its mechanism of action is unique compared with that of traditional sedatives because it does not act on γ-aminobutyric acid receptors. In addition, dexmedetomidine lacks anticholinergic activity and promotes a natural sleep pattern. These pharmacologic characteristics may explain the possible anti delirium effects of dexmedetomidine. Eight clinical trials, including 5 double-blind randomized trials, were reviewed to evaluate the impact of dexmedetomidine on ICU delirium.
Currently available evidence suggests that dexmedetomidine is a promising agent, not only for prevention but also for treatment of ICU-associated delirium. However, larger, well-designed trials are warranted to define the role of dexmedetomidine in preventing and treating delirium in the ICU.
回顾最近关于右美托咪定在预防和治疗重症监护病房（ICU）患者谵妄方面作用的临床研究。
使用关键词谵妄、右美托咪定、Precedex、躁动、α-2 激动剂、重症监护和强化护理，对 MEDLINE 和 PubMed 搜索（1988 年-2013 年 2 月）进行了检索。查阅相关文章的参考文献以获取更多信息。
选择了比较右美托咪定与其他镇静剂/镇痛药或与抗精神病药治疗谵妄的临床试验。评估右美托咪定用于镇静超过 6 小时的研究包括在本综述中。
右美托咪定是一种高度选择性的α-2 受体激动剂，具有镇静、抗焦虑和适度的镇痛作用，呼吸抑制作用最小。与传统镇静剂相比，其作用机制独特，因为它不作用于γ-氨基丁酸受体。此外，右美托咪定缺乏抗胆碱能活性，并促进自然睡眠模式。这些药理特性可能解释了右美托咪定抗谵妄的可能作用。回顾了 8 项临床试验，包括 5 项双盲随机试验，以评估右美托咪定对 ICU 谵妄的影响。
目前的证据表明，右美托咪定不仅是预防，而且是治疗 ICU 相关性谵妄的一种有前途的药物。然而，需要更大规模、精心设计的试验来确定右美托咪定在预防和治疗 ICU 谵妄中的作用。
