Miyoshi Yukiko, Shigetsura Yuki, Hira Daiki, Maki Takakuni, Kawashima Hirotsugu, Sugita Naoko, Sugawara Noriko, Kitada Noriaki, Hirai Machiko, Kawata Masayoshi, Endo Hiroki, Kojima Yusuke, Ikuta Keiko, Katsube Yurie, Imayoshi Natsuki, Nakagawa Shunsaku, Tsuda Masahiro, Terada Tomohiro
Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, 54 Shogoin- Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Neurology, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
J Pharm Health Care Sci. 2024 Nov 18;10(1):74. doi: 10.1186/s40780-024-00397-z.
Post-stroke delirium affects between 24% and 43% of patients, and negatively impacts patient outcomes. Recently, research attention has been on preventive interventions for delirium, with melatonin receptor agonists and orexin receptor antagonists reported to be effective in preventing delirium in intensive care unit patients. However, the efficacy of these agents in preventing post-stroke delirium remain unclear. This study examined the efficacy of ramelteon, suvorexant, and lemborexant in preventing post-stroke delirium symptoms in patients with stroke.
A retrospective survey of medical records was conducted for patients with stroke aged > 75 years at Kyoto University Hospital from October 2021 to March 2023. Patients who received ramelteon, suvorexant, or lemborexant on admission and the following day were classified into the consecutive administration group, whereas those who did not were classified into the non-consecutive administration group. The primary outcome was an increase in the number of positive items in the delirium screening tool over 7 days.
Of the 104 patients, 33 and 71 were in the consecutive and non-consecutive administration groups, respectively. Fewer patients in the consecutive administration group had an increase in the number of positive items than in the other group (6% vs. 21%). Patients in the consecutive administration group significantly less often had an increase in the number of positive items in the delirium screening tool (P = 0.05; hazard ratio, 0.27; 95% confidence interval, 0.10-0.75).
This study revealed that early administration of a melatonin receptor agonist or orexin receptor antagonists may effectively prevent post-stroke delirium in older patients.
中风后谵妄影响24%至43%的患者，并对患者预后产生负面影响。最近，研究重点一直放在谵妄的预防性干预措施上，据报道褪黑素受体激动剂和食欲素受体拮抗剂对预防重症监护病房患者的谵妄有效。然而，这些药物在预防中风后谵妄方面的疗效仍不明确。本研究探讨了雷美替胺、苏沃雷生和伦博雷生在预防中风患者中风后谵妄症状方面的疗效。
对2021年10月至2023年3月在京都大学医院年龄大于75岁的中风患者的病历进行回顾性调查。入院时及次日接受雷美替胺、苏沃雷生或伦博雷生治疗的患者被分为连续给药组，未接受治疗的患者被分为非连续给药组。主要结局是谵妄筛查工具中阳性项目数量在7天内的增加。
104例患者中，连续给药组和非连续给药组分别有33例和71例。连续给药组阳性项目数量增加的患者少于另一组（6%对21%）。连续给药组患者谵妄筛查工具中阳性项目数量增加的情况明显较少（P = 0.05；风险比，0.27；95%置信区间，0.10 - 0.75）。
本研究表明，早期给予褪黑素受体激动剂或食欲素受体拮抗剂可能有效预防老年患者中风后谵妄。
