Swart Lieke M, van der Zanden Vera, Spies Petra E, de Rooij Sophia E, van Munster Barbara C
Department of Internal Medicine, Geriatrics Section, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Gelre Hospitals, Department of Geriatric Medicine, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, The Netherlands.
Drugs Aging. 2017 Jun;34(6):437-443. doi: 10.1007/s40266-017-0455-9.
There is substantial evidence that the use of opioids increases the risk of adverse outcomes such as delirium, but whether this risk differs between the various opioids remains controversial. In this systematic review, we evaluate and discuss possible differences in the risk of delirium from the use of various types of opioids in older patients.
We performed a search in MEDLINE by combining search terms on delirium and opioids. A specific search filter for use in geriatric medicine was used. Quality was scored according to the quality assessment for cohort studies of the Dutch Cochrane Institute.
Six studies were included, all performed in surgical departments and all observational. No study was rated high quality, one was rated moderate quality, and five were rated low quality. Information about dose, route, and timing of administration of the opioid was frequently missing. Pain and other important risk factors of delirium were often not taken into account. Use of tramadol or meperidine was associated with an increased risk of delirium, whereas the use of morphine, fentanyl, oxycodone, and codeine were not, when compared with no opioid. Meperidine was also associated with an increased risk of delirium compared with other opioids, whereas tramadol was not. The risk of delirium appeared to be lower with hydromorphone or fentanyl, compared with other opioids. Numbers used for comparisons were small.
Some data suggest that meperidine may lead to a higher perioperative risk for delirium; however, high-quality studies that compare different opioids are lacking. Further comparative research is needed.
有大量证据表明使用阿片类药物会增加诸如谵妄等不良后果的风险，但不同阿片类药物之间的这种风险是否存在差异仍存在争议。在本系统评价中，我们评估并讨论老年患者使用不同类型阿片类药物导致谵妄风险的可能差异。
我们通过结合谵妄和阿片类药物的检索词在医学文献数据库（MEDLINE）中进行检索。使用了用于老年医学的特定检索过滤器。根据荷兰 Cochrane 研究所队列研究的质量评估对质量进行评分。
纳入了六项研究，均在外科进行且均为观察性研究。没有一项研究被评为高质量，一项被评为中等质量，五项被评为低质量。阿片类药物的剂量、给药途径和给药时间信息经常缺失。疼痛和其他谵妄的重要风险因素常常未被考虑。与未使用阿片类药物相比，使用曲马多或哌替啶与谵妄风险增加相关，而使用吗啡、芬太尼、羟考酮和可待因则不然。与其他阿片类药物相比，哌替啶也与谵妄风险增加相关，而曲马多则不然。与其他阿片类药物相比，氢吗啡酮或芬太尼导致谵妄的风险似乎较低。用于比较的数据量较小。
一些数据表明哌替啶可能导致围手术期谵妄风险更高；然而，缺乏比较不同阿片类药物的高质量研究。需要进一步的比较研究。
