预防性使用氟哌啶醇对谵妄高风险的III级危重患者长期生活质量的影响
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Prophylactic Haloperidol Effects on Long-term Quality of Life in Critically Ill Patients at High Risk for Delirium：Results of the REDUCE Study
背景与目的
重症监护病房患者谵妄发生率高，且与长期预后受损有关。预防性使用氟哌啶醇并没有改善谵妄高风险的危重患者的短期预后。本研究评估预防性使用氟哌啶醇对这些患者长期生活质量的影响，并探讨哪些因素与生活质量的改变有关。
方 法
对ICU里谵妄高风险的危重患者预防性使用氟哌啶醇治疗谵妄的远期疗效进行预先计划的二次分析。在这个多中心随机临床试验中，无谵妄的ICU患者分为预防性使用氟哌啶醇组(1或2mg)或安慰剂组(0.9%氯化钠)。两组患者最终接受研究药物治疗的平均时间为3天(四分位范围内，2至6天)，直到出现谵妄或从ICU出院。在ICU入院时(基线)和入院后1个月和6个月，采用短表格-12调查表评估长期疗效。生活质量的总结分为身体方面总结和心理方面总结两部分。分析氟哌啶醇组与安慰剂组之间的差异以及与生活质量变化相关的因素。
结 果
共1789名患者，纳入了1245名ICU患者，其中887名(71%)接受了氟哌啶醇治疗。氟哌啶醇组与安慰剂组的长期生活质量无显著差异(身体方面汇总平均得分分别为3911分和3911分，P = 0.350;心理方面总分分别为50分±10分和51分±10分，P = 0.678)。年龄、医疗和创伤入院、基线生活质量评分、谵妄风险(谵妄前)评分、镇静诱导的昏迷天数与长期生活质量下降显著相关。
结 论
预防性使用氟哌啶醇不会影响高风险谵妄的III级危重患者长期生活质量。有几个因素，包括可调整的镇静诱导昏迷天数，与长期预后的下降有关。
原始文献摘要
Paul J. T. Rood, R.N., M.Sc, et al. Prophylactic Haloperidol Effects on Long-term Quality of Life in Critically Ill Patients at High Risk for Delirium：Results of the REDUCE Study[J] .Anesthesiology 2019; 131:328–335
Background: Delirium incidence in intensive care unit patients is high and associated with impaired long-term outcomes. The use of prophylactic haloperidol did not improve short-term outcome among critically ill adults at high risk of delirium. This study evaluated the effects of prophylactic haloperidol use on long-term quality of life in this group of patients and explored which factors are associated with change in quality of life.
Methods: A preplanned secondary analysis of long-term outcomes of the pRophylactic haloperidol usE for DeliriUm in iCu patients at high risk for dElirium (REDUCE) study was conducted. In this multicenter randomized clinical trial, nondelirious intensive care unit patients were assigned to prophylactic haloperidol (1 or 2 mg) or placebo (0.9% sodium chloride). In all groups, patients finally received study medication for median duration of 3 days [interquartile range, 2 to 6] until onset of delirium or until intensive care unit discharge. Long-term outcomes were assessed using the Short Form-12 questionnaire at intensive care unit admission (baseline) and after 1 and 6 months. Quality of life was summarized in the physical component summary and mental component summary scores. Differences between the haloperidol and placebo group and factors associated with changes in quality of life were analyzed.
Results: Of 1,789 study patients, 1,245 intensive care unit patients were approached, of which 887 (71%) responded. Long-term quality of life did not differ between the haloperidol and placebo group (physical component summary mean score of 39 11 and 39 11, respectively, and P = 0.350; and mental component summary score of 50 10 and 51 10, respectively, and P = 0.678). Age, medical and trauma admission, quality of life score at baseline, risk for delirium (PRE-DELIRIC) score, and the number of sedation-induced coma days were significantly associated with a decline in long-term quality of life.
Conclusions: Prophylactic haloperidol use does not affect long-term quality of life in critically ill patients at high risk for delirium. Several factors, including the modifiable factor number of sedation-induced coma days, are associated with decline in long-term outcomes.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：余晓旭 编辑：何幼芹 审校：王贵龙