Department of Intensive Care Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China.
Department of Hematology, Affiliated Hospital of Guizhou Medical University, Guiyang, China -
Minerva Anestesiol. 2021 Jan;87(1):65-76. doi: 10.23736/S0375-9393.20.14492-4. Epub 2020 Dec 10.
Although dexmedetomidine has been found to prevent delirium in critically ill patients, it is uncertain whether it can treat acute delirium. This study aimed to evaluate the efficacy and safety of dexmedetomidine in treating delirium, by analyzing and reviewing data from previous studies.
Clinical trial data on the use of dexmedetomidine in adult critically ill patients with delirium were retrieved from four databases (PubMed, Embase, Web of Science, and the Cochrane Library) and clinicaltrials.gov, from inception to May, 2020.
Ten randomized controlled trials (RCTs) and five non-RCTs met the selection criteria and data were obtained from 1017 patients. In one study, dexmedetomidine reduced the duration of delirium to a greater extent than did the placebo. In six studies, it was associated with a lower point-prevalence of delirium after treatment (OR, 0.39; 95% CI, 0.20, 0.76; P=0.006) and a shorter time to resolution of delirium (hours; MD, -23.25; 95% CI, -45.28, -1.21; P=0.04) compared with those of other drugs. In four RCTs, it was superior to haloperidol in reducing the time to resolution of delirium (hours; MD, -30.17; P=0.01). However, in seven studies, it showed a higher risk of bradycardia (OR, 3.48; 95% CI, 1.47, 8.23; P=0.004) than that of comparators.
Dexmedetomidine promotes the resolution of delirium but also increases the incidence of bradycardia during treatment. Furthermore, it may be superior to haloperidol in treating delirium, although more studies are needed to confirm this.
虽然右美托咪定已被发现可预防危重症患者的谵妄，但尚不确定其是否可治疗急性谵妄。本研究旨在通过分析和回顾以往研究的数据，评估右美托咪定治疗谵妄的疗效和安全性。
从四个数据库（PubMed、Embase、Web of Science 和 Cochrane Library）和 clinicaltrials.gov 检索到使用右美托咪定治疗成人危重症谵妄患者的临床试验数据，检索时间为 2020 年 5 月之前。
符合选择标准的十项随机对照试验（RCT）和五项非 RCT 纳入研究，共纳入 1017 例患者的数据。在一项研究中，与安慰剂相比，右美托咪定可显著缩短谵妄持续时间。在六项研究中，右美托咪定治疗后谵妄的时点患病率更低（OR 0.39，95%CI 0.200.76；P=0.006），谵妄缓解时间更短（小时，MD-23.25，95%CI-45.28-1.21；P=0.04），与其他药物相比。在四项 RCT 中，右美托咪定在缩短谵妄缓解时间方面优于氟哌啶醇（小时，MD-30.17，P=0.01）。但在七项研究中，与对照药物相比，右美托咪定更易导致心动过缓（OR 3.48，95%CI 1.47~8.23；P=0.004）。
右美托咪定可促进谵妄缓解，但在治疗过程中也会增加心动过缓的发生率。此外，其治疗谵妄的疗效可能优于氟哌啶醇，但还需要更多研究加以证实。
