Stichting Apotheek der Haarlemse ziekenhuizen, Haarlem, The Netherlands.
Department of Clinical Pharmacy, Ter Gooi Ziekenhuizen, Hilversum, The Netherlands.
Brain Behav. 2021 Dec;11(12):e2404. doi: 10.1002/brb3.2404. Epub 2021 Nov 10.
Anticholinergic acting drugs have been associated with delirium in older patients.
To examine the association between the anticholinergic burden (ACB) and the duration and severity of delirium in older hip-surgery patients with or without haloperidol prophylaxis.
Older patients with a postoperative delirium following hip surgery from a randomized controlled trial investigating the effects of haloperidol prophylaxis on delirium incidence were included in this study. The ACB was quantified using two different tools, the Anticholinergic Drug Scale and an Expert Panel. Using linear regression, the association between the ACB and delirium was analyzed.
Overall delirium duration and severity were not significantly associated with the ACB. Also, no statistically significant differences were found in delirium duration or severity between the placebo and haloperidol treatment groups for the ACB groups. The protective effect of haloperidol on delirium duration and severity however tended to be present in patients with no or a low ACB but not or to a lesser extent in patients with an intermediate to high ACB.
The ACB was not significantly associated with delirium duration or severity. Haloperidol prophylaxis tended to shorten delirium duration and decrease delirium severity in patients with no or a low ACB. To further explore the influence of anticholinergic acting drugs on delirium duration and severity and the effect of concomitant haloperidol use, additional research with a higher haloperidol dose, a larger study population, and ACB quantification taking drug exposure into account is warranted.
抗胆碱能药物与老年患者的谵妄有关。
研究髋部手术后老年患者的抗胆碱能药物负担（ACB）与谵妄的持续时间和严重程度之间的关系，这些患者中有或没有氟哌啶醇预防。
本研究纳入了一项随机对照试验，该试验研究了氟哌啶醇预防对谵妄发生率的影响，纳入了髋部手术后出现术后谵妄的老年患者。使用两种不同的工具，即抗胆碱能药物量表和专家小组，来量化 ACB。使用线性回归分析 ACB 与谵妄之间的关系。
总体而言，谵妄的持续时间和严重程度与 ACB 无显著相关性。此外，在 ACB 组中，氟哌啶醇治疗组与安慰剂治疗组之间，谵妄的持续时间或严重程度也没有统计学上的显著差异。然而，氟哌啶醇对谵妄持续时间和严重程度的保护作用似乎存在于无或低 ACB 的患者中，但在中至高 ACB 的患者中则不存在或程度较小。
ACB 与谵妄的持续时间或严重程度无显著相关性。氟哌啶醇预防在无或低 ACB 的患者中倾向于缩短谵妄的持续时间并降低谵妄的严重程度。为了进一步探讨抗胆碱能药物对谵妄持续时间和严重程度的影响以及氟哌啶醇联合使用的效果，需要进行额外的研究，使用更高的氟哌啶醇剂量、更大的研究人群，并考虑药物暴露来量化 ACB。
