地塞米松和奥氮平是否适合控制重症老年患者的谵妄？一项回顾性队列研究。

Are dexmedetomidine and olanzapine suitable to control delirium in critically ill elderly patients? A retrospective cohort study.

机构信息

Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; Intensive Care Unit, Dalian Municipal Central Hospital, Dalian 116033, China.

Intensive Care Unit, Dalian Municipal Central Hospital, Dalian 116033, China.

出版信息

Biomed Pharmacother. 2021 Jul;139:111617. doi: 10.1016/j.biopha.2021.111617. Epub 2021 Apr 26.

DOI:10.1016/j.biopha.2021.111617

PMID:33915500

Abstract

BACKGROUND

The efficacy and safety of dexmedetomidine and olanzapine for delirium control in critically ill elderly patients without ventilation or surgery are not known.

METHODS

The efficacy and safety of dexmedetomidine and olanzapine for controlling delirium were evaluated in a retrospective cohort of critically illness by assessing the sedation level, drug dose/duration, combination rate with other sedatives, adverse effects, intubation rate and prognosis.

RESULT

The maximum (1.61 ± 1.56 vs. 2.70 ± 1.01, p < 0.001), average (-0.57 ± 0.88 vs. 0.88 ± 0.73, p < 0.001), and minimum (-1.67 ± 1.04 vs. -1.37 ± 1.01, p = 0.014) RASS scores of 263 patients were lower after treating with dexmedetomidine than treating with olanzapine. Drug use duration (4.83 ± 2.67 days vs. 5.87 ± 3.14 days, p = 0.005) and sedative combination rates (13.56% vs. 40.00%, p = 0.003) were lower when treating with dexmedetomidine than that with olanzapine. A comparison of adverse effects between dexmedetomidine and olanzapine revealed respiratory depression (16.95% vs. 2.84%, p < 0.001), hypoxia (13.56% vs. 2.76%, p < 0.001) and hypotension (11.02% vs. 3.45%, p = 0.007). Intubation rates (22.88% vs. 12.41%, p = 0.023) and the length of hospital stay (9.30 ± 4.90 days vs. 8.83 ± 3.34 days, p < 0.001) were higher in patients treated with dexmedetomidine than that with olanzapine. Mortality rates, cognitive prognosis, and delirium recurrence rates were similar between groups. Age, severe cardiopulmonary disease, APACHE II scores, dexmedetomidine dose, minimum RASS score and sedative combination were significantly (p < 0.05) associated with the adverse effects of dexmedetomidine. Respiratory depression, hypoxia and hypotension in the olanzapine group all occurred during combination with benzodiazepines.

CONCLUSIONS

Dexmedetomidine achieved more satisfactory sedative effects on delirium control, but olanzapine was safer.

摘要

背景

对于无通气或手术的危重症老年患者，右美托咪定和奥氮平控制谵妄的疗效和安全性尚不清楚。

方法

通过评估镇静水平、药物剂量/持续时间、与其他镇静剂联合使用的比率、不良反应、插管率和预后，对右美托咪定和奥氮平控制谵妄的疗效和安全性进行了回顾性队列研究。

结果

263 例患者使用右美托咪定治疗后的最大（1.61±1.56 比 2.70±1.01，p<0.001）、平均（-0.57±0.88 比 0.88±0.73，p<0.001）和最小（-1.67±1.04 比-1.37±1.01，p=0.014）RASS 评分均低于奥氮平治疗组。右美托咪定治疗的药物使用时间（4.83±2.67 天比 5.87±3.14 天，p=0.005）和镇静剂联合使用率（13.56%比 40.00%，p=0.003）均低于奥氮平治疗组。右美托咪定与奥氮平的不良反应比较，发现呼吸抑制（16.95%比 2.84%，p<0.001）、缺氧（13.56%比 2.76%，p<0.001）和低血压（11.02%比 3.45%，p=0.007）发生率较高。插管率（22.88%比 12.41%，p=0.023）和住院时间（9.30±4.90 天比 8.83±3.34 天，p<0.001）在右美托咪定治疗组均高于奥氮平治疗组。两组死亡率、认知预后和谵妄复发率相似。年龄、严重心肺疾病、APACHE II 评分、右美托咪定剂量、最小 RASS 评分和镇静剂联合使用与右美托咪定的不良反应显著相关（p<0.05）。奥氮平组的呼吸抑制、缺氧和低血压均发生在与苯二氮䓬类药物联合使用时。