Skelton Luke, Guo Ping
South London and the Maudsley NHS Trust.
Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.
Curr Opin Support Palliat Care. 2019 Dec;13(4):384-391. doi: 10.1097/SPC.0000000000000458.
There is a high prevalence of delirium in palliative care patients. This review aims to evaluate the effects of the pharmacological and nonpharmacological interventions used to manage delirium symptoms in this patient group.
A recent study has suggested there is no role for antipsychotic medication in the management of delirium in palliative care patients, which is a move away from previous expert opinion. In addition, recent findings suggest there may be a role for the use of antipsychotics in combination with benzodiazepines in the management of agitated delirium.
It is too early to abandon the use of antipsychotic medication entirely in the management of delirium, however there remains inadequate evidence to support the routine use of either pharmacological or nonpharmacological interventions for delirium treatment. Clinicians should determine the delirium subtype and severity, using this to inform the most appropriate pharmacological treatment if required. Further rigorously designed research is needed to seek clarity over whether the alleviation of symptoms is dose dependent, and to determine whether there is a severity threshold over which pharmacological interventions are most effective. Future research is required to evaluate nonpharmacological interventions in this population.
姑息治疗患者中谵妄的患病率很高。本综述旨在评估用于管理该患者群体谵妄症状的药物和非药物干预措施的效果。
最近一项研究表明，抗精神病药物在姑息治疗患者谵妄管理中没有作用，这与之前的专家意见不同。此外，最近的研究结果表明，抗精神病药物与苯二氮䓬类药物联合使用在激越性谵妄管理中可能有作用。
完全放弃使用抗精神病药物来管理谵妄还为时过早，然而，仍然没有足够的证据支持常规使用药物或非药物干预措施来治疗谵妄。临床医生应确定谵妄的亚型和严重程度，并在需要时据此选择最合适的药物治疗。需要进一步进行严格设计的研究，以明确症状缓解是否与剂量有关，并确定是否存在一个严重程度阈值，超过该阈值药物干预最为有效。未来需要开展研究来评估该人群中的非药物干预措施。
