John Carol J, Engler Meghan, Zaki Hania, Crooker Anna, Cabrera Maria, Golden Cassidy, Whitehill Robert, Xiang Yijin, Liu Katie, Fundora Michael P
Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA.
Department of Pediatrics, Children's Healthcare of Atlanta Cardiology, Emory University, Atlanta, GA, USA.
Cardiol Young. 2024 May 24:1-5. doi: 10.1017/S1047951124025162.
Children with prolonged hospital admissions for CHD often develop delirium. Antipsychotic medications (APMs) have been used to treat delirium but are known to prolong the QTc duration. There is concern for prolongation of the QTc interval in cardiac patients who may be more vulnerable to electrocardiogram (ECG) changes and may have postoperative QTc prolongation already. The goal of this study was to determine the effect of APM on QTc duration in postoperative paediatric cardiac patients and determine the effect of quetiapine and risperidone in treating delirium and QTc prolongation.
Retrospective study, July 1, 2017-May 31, 2022.
Tertiary children's hospital.
Included were patients admitted to the paediatric cardiac ICU at Children's Healthcare of Atlanta.
None.
ECGs, delirium scores, and drug information were collected. Delirium was defined as Cornell Assessment of Pediatric Delirium (CAPD) score >9. Mixed effect models were performed to evaluate the effect of surgery on QTc change and the effect of antipsychotics on QTc and CAPD changes. There were 139 children, 55% male and 67% surgical admissions. Median age was 5.9 months. Mean QTc increased after cardiac surgery by 18 ms (p = 0.014, 95% CI 3.65-32.4). There was no significant change in QTc after antipsychotic administration (p = 0.064). The mean CAPD score decreased (12.5-7.2; p < 0.001). Quetiapine had the most improvement in delirium, and risperidone had the least improvement (77.8%, n = 14; 37.8%, n = 34, respectively; p = 0.002).
The QTc interval did not have a statistically significant change after the administration of antipsychotics, while there was improvement in the CAPD score. APMs may be administered safely without significant prolongation of the QTc and are an effective treatment for delirium.
因先天性心脏病（CHD）而长期住院的儿童常出现谵妄。抗精神病药物（APMs）已被用于治疗谵妄，但已知会延长QTc间期。对于可能更容易出现心电图（ECG）变化且术后可能已经存在QTc延长的心脏病患者，人们担心其QTc间期会延长。本研究的目的是确定APM对小儿心脏术后患者QTc间期的影响，并确定喹硫平和利培酮在治疗谵妄和QTc延长方面的效果。
回顾性研究，2017年7月1日至2022年5月31日。
三级儿童医院。
纳入的是亚特兰大儿童医疗保健中心儿科心脏重症监护病房收治的患者。
无。
收集心电图、谵妄评分和药物信息。谵妄定义为康奈尔儿童谵妄评估（CAPD）评分>9。采用混合效应模型评估手术对QTc变化的影响以及抗精神病药物对QTc和CAPD变化的影响。共有139名儿童，55%为男性，67%为手术入院患者。中位年龄为5.9个月。心脏手术后平均QTc增加了18毫秒（p = 0.014，95%置信区间3.65 - 32.4）。使用抗精神病药物后QTc无显著变化（p = 0.064）。平均CAPD评分降低（从12.5降至7.2；p < 0.001）。喹硫平对谵妄的改善最为明显，利培酮的改善最少（分别为77.8%，n = 14；37.8%，n = 34；p = 0.002）。
使用抗精神病药物后QTc间期无统计学显著变化，而CAPD评分有所改善。APMs可以安全使用，不会显著延长QTc，是治疗谵妄的有效方法。
