術後の妄想と精神活性薬との関係
E R Marcantonio1, G Juarez, L Goldman
1Section for Clinical Epidemiology, Brigham and Women's Hospital, Boston, MA 02115.
JAMA
|November 16, 1994
まとめ
術後の妄想はメペリジンおよびベンゾジアゼピン使用と関連しています. 臨床医は,これらの薬が妄想の可能性を大幅に増加させるため,リスクのある患者にとって代替案を検討する必要があります.
科学分野:
- アネステシオロジー アネステシオロジー
- ゲロントロジーはゲロントロジーの学科です.
- 薬理学 薬理学とは
背景:
- 手術後の妄想症 (POD) は,特に高齢者の間で一般的な合併症です.
- 精神活性成分を持つ薬剤は,PODに寄与すると疑われる.
- 特定の高リスク医薬品を特定することは,予防戦略にとって極めて重要です.
研究 の 目的:
- 特定の精神活性薬と術後の妄想の発症の関連性を調査する.
- よく使用される術後薬によるリスクを定量化するために.
主な方法:
- 将来のコホートの中で,内蔵された症例対照研究が行われました.
- 妄想を発症した患者 (症例) は,検証された妄想リスク予測モデルに基づく対照群とマッチングされた.
- 薬物暴露 (麻薬,ベンゾジアゼピン,抗コレリン薬) は,妄想発症前の24時間またはそれと同等の術後の期間で評価されました.
主要な成果:
- メペリジン (OR,2.7) とベンゾジアゼピン (OR,3.0) に対する術後の暴露は,デリリウムのリスクの増加と有意に関連していました.
- 長期にわたって作用するベンゾジアゼピンとより高い用量は,より強い関連性を示す傾向を示した.
- 麻薬および抗コレリン作用薬のクラスは,デリリウムと有意に関連していなかったが,これは統計力の制限による可能性がある.
結論:
- メペリジンとベンゾジアゼピンは,手術後の妄想の重要な危険因子です.
- 臨床医は,リスクの高い患者にこれらの薬を処方する際に注意を払うべきです.
- 妄想のリスクを軽減するために,代替の痛みと鎮静管理戦略を検討する必要があります.
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