抗精神病药物和重症监护室狂妄期间的QTc间隔:随机临床试验的二次分析
Joanna L Stollings1,2, Christina S Boncyk1,3, Caroline I Birdrow1,4
1Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, Tennessee.
JAMA network open
|January 22, 2024
概括
像哈洛佩里多尔和齐普拉西这样的抗精神病药物没有显著地延长重症监护室 (ICU) 狂妄症患者的QTc间隔. 对于这些基线QTc正常的患者,例行QTc监测可能是不必要的.
科学领域:
- 心脏病学 心脏病学
- 密集护理医学 密集护理医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 抗精神病药物经常用于重症监护室 (ICU) 的妄想管理.
- 人们担心抗精神病药物可能导致QTc间隔延长,这是严重心律不整的危险因素.
研究的目的:
- 调查抗精神病药物是否会增加在ICU环境中 Delirium 发生的患者的 QTc 间隔.
- 在这个患者群体中,与安慰剂相比,评估利和齐普拉西的安全性和有效性.
主要方法:
- 一项随机临床试验,涉及566名在美国16个中心医疗/外科ICU Delirium 的成年患者.
- 参与者每天两次接受静脉注射利,齐普拉西或盐水安慰剂,直到妄症解决,重症监护室出院或14天.
- 电心电图 (ECG) 和遥测被用来测量QTc间隔,多变量回归分析了对第二天最大QTc的影响.
主要成果:
- 与安慰剂相比,haloperidol和ziprasidone都没有与第二天的QTc间隔显著增加相关 (分别为0.95和1.09;P>0.05).
- 基线QTc间隔和日常变化在所有治疗组中都是最小的.
- 在haloperidol组中发生了两个非致命的torsade de pointes病例,但与研究药物管理没有明确联系.
结论:
- 在ICU患有妄和正常基线QTc间隔的患者中,使用抗精神病药物 (haloperidol,ziprasidone) 并没有显著延长QTc间隔.
- 在这个特定的患者群体中,日常的QTc间隔监测可能具有有限的临床价值.
- 进一步的研究可能有必要在患有先前存在的危险因素或延长基线QTc的患者中探索QTc延长风险.
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