术后妄想与精神活性药物的关系
E R Marcantonio1, G Juarez, L Goldman
1Section for Clinical Epidemiology, Brigham and Women's Hospital, Boston, MA 02115.
JAMA
|November 16, 1994
概括
手术后妄与美二和二二使用有关. 临床医生应考虑为风险患者提供替代药物,因为这些药物显著增加了妄想的可能性.
科学领域:
- 麻醉学 麻醉学
- 老年学是指老年学的学科.
- 药理学 药理学是指药理学的学科.
背景情况:
- 手术后痴呆症 (POD) 是一种常见的并发症,特别是在老年人中.
- 具有精神活性性质的药物被怀疑是导致POD的因素.
- 识别特定的高风险药物对于预防策略至关重要.
研究的目的:
- 调查特定的精神活性药物与术后妄想症的发展之间的关联.
- 量化通常使用的术后药物所带来的风险.
主要方法:
- 在一个前性队列中进行了一项嵌套病例控制研究.
- 患有 Delirium (病例) 的患者与基于经过验证的 Delirium 风险预测模型的对照组相匹配.
- 药物暴露 (麻醉剂,二类药物,抗胆固醇药物) 在 Delirium 发作前 24 小时或相应的术后期间被评估.
主要成果:
- 手术后暴露于美佩里丁 (OR,2.7) 和二 (OR,3.0) 与 Delirium 的风险增加显著相关.
- 长效二类药物和较高剂量显示出一种更强烈的关联的趋势.
- 作为类别的麻醉剂和抗胆固醇药物与妄想没有显著的关联,可能是由于有限的统计能力.
结论:
- 梅佩里丁和二是术后 Delirium 的重要危险因素.
- 临床医生在给有风险的患者开这些药物时应谨慎行事.
- 应考虑替代疼痛和镇静管理策略,以减轻妄想风险.
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