Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative and Supportive Care, University of Tsukuba Hospital, Tsukuba, Japan.
Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
J Pain Symptom Manage. 2024 May;67(5):441-452.e3. doi: 10.1016/j.jpainsymman.2024.02.008. Epub 2024 Feb 12.
Antipsychotics are often used in managing symptoms of terminal delirium, but evidence is limited.
To explore the comparative effectiveness of haloperidol with as-needed benzodiazepines (HPD) vs. chlorpromazine (CPZ) vs. levomepromazine (LPZ) for agitated delirium in the last days.
A prospective observational study was conducted in two palliative care units in Japan. Adult cancer patients who developed agitated delirium with a modified Richmond Agitation-Sedation Scale (RASS-PAL) of one or more were included; palliative care specialist physicians determined that the etiology was irreversible; and estimated survival was 3 weeks or less. Patients treated with HPD, CPZ, or LPZ were analyzed. We measured RASS, NuDESC, Agitation Distress Scale (ADS), and Communication Capacity Scale (CCS) on Days 1 and 3.
A total of 277 patients were enrolled, and 214 were analyzed (112 in HPD, 50 in CPZ, and 52 in LPZ). In all groups, the mean RASS-PAL score significantly decreased on Day 3 (1.37 to -1.01, 1.87 to -1.04, 1.79 to -0.62, respectively; P < 0.001); the NuDESC and ADS scores also significantly decreased. The percentages of patients with moderate to severe agitation and those with full communication capacity on Day 3 were not significantly different. The treatments were well-tolerated. While one-fourth of HPD group changed antipsychotics, 88% or more of CPZ and LPZ groups continued the initial antipsychotics.
Haloperidol with as-needed benzodiazepine, chlorpromazine, or levomepromazine may be effective and safe for terminal agitation. Chlorpromazine and levomepromazine may have an advantage of no need to change medications.
抗精神病药常用于治疗终末期谵妄的症状，但证据有限。
探索氟哌啶醇按需联合苯二氮䓬类药物（HPD）与氯丙嗪（CPZ）或左美丙嗪（LPZ）治疗临终前躁动的疗效比较。
本前瞻性观察性研究在日本的两个姑息治疗病房进行。纳入患有躁动谵妄的成年癌症患者，改良的 Richmond 躁动-镇静量表（RASS-PAL）评分为 1 分或更高，姑息治疗专家医生判断病因不可逆转，预计生存时间为 3 周或更短。分析接受 HPD、CPZ 或 LPZ 治疗的患者。我们在第 1 天和第 3 天测量 RASS、NuDESC、躁动痛苦量表（ADS）和沟通能力量表（CCS）。
共纳入 277 例患者，214 例患者纳入分析（HPD 组 112 例，CPZ 组 50 例，LPZ 组 52 例）。所有组的 RASS-PAL 评分在第 3 天均显著降低（1.37 降至-1.01，1.87 降至-1.04，1.79 降至-0.62；P<0.001），NuDESC 和 ADS 评分也显著降低。第 3 天，中度至重度躁动患者和完全沟通能力患者的比例无显著差异。治疗均耐受良好。HPD 组中有四分之一的患者更换了抗精神病药，CPZ 和 LPZ 组中 88%或更多的患者继续使用初始抗精神病药。
氟哌啶醇按需联合苯二氮䓬类药物、氯丙嗪或左美丙嗪可能对终末期躁动有效且安全。氯丙嗪和左美丙嗪可能无需换药。
