Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery
Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery
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DOI：
10.1177/0310057x0703500509
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发表时间：
2007-10-01
影响因子：
1.5
通讯作者：
Prapaitrakool, S.
中科院分区：
文献类型：
--
作者：
Prakanrattana, U.;Prapaitrakool, S.
这项随机、双盲、安慰剂对照研究的主要目的是评价利培酮预防体外循环心脏手术后妄想的可能性，次要目标是探索与术后妄想相关的临床因素。126名接受择期心脏手术体外循环的成年患者被随机分配到苏醒时接受1 mg利培酮或安慰剂。对精神错乱和其他结果进行评估。采用重症监护病房混乱评定法评定术后精神障碍，利培酮组术后精神障碍发生率为11.1%，明显低于安慰剂组(31.7%，P=0.009)，相对危险度为0.35，95%可信区间为0.16~0.77。两组之间的其他术后结果在统计学上没有差异。在探索与妄想相关的因素时，单因素分析显示许多因素与术后妄想有关。多因素Logistic回归分析显示，睁眼至听从指令70min和术后呼吸衰竭是独立的危险因素(P=0.003，OR=4.57，95%CI=1.66~12.59和P=0.038，OR=13.78，95%CI=1.15~165.18)。术后神志不清与多种因素有关，但在本研究中，只有从睁眼到听从指令的时间和术后呼吸衰竭是独立的危险因素。
This randomised, double-blinded, placebo-controlled study was primarily aimed to evaluate the potential of risperidone to prevent postoperative delirium following cardiac surgery with cardiopulmonary bypass and the secondary objective was to explore clinical factors associated with postoperative delirium.One-hundred-and-twenty-six adult patients undergoing elective cardiac surgery with cardiopulmonary bypass were randomly assigned to receive either 1 mg of risperidone or placebo sublingually when they regained consciousness. Delirium and other outcomes were assessed. The confusion assessment method for intensive care unit was used to assess postoperative delirium.The incidence of postoperative delirium in the risperidone group was lower than the placebo group (11.1% vs. 31.7% respectively, P=0.009, relative risk=0.35, 95% confidence interval [CI]=0.16-0.77). Other postoperative outcomes were not statistically different between the groups. In exploring the factors associated with delirium, univariate analysis showed many factors were associated with postoperative delirium. However multiple logistic regression analysis showed a lapse of 70 minutes from the time of opening eyes to following commands and postoperative respiratory failure were independent risk factors (P=0.003, odds ratio [OR]=4.57, 95% CI=1.66-12.59 and P=0.038, OR=13.78, 95% CI=1.15-165.18 respectively).A single dose of risperidone administered soon after cardiac surgery with cardiopulmonary bypass reduces the incidence of postoperative delirium. Multiple factors tended to be associated with postoperative delirium, but only the time from opening eyes to following commands and postoperative respiratory failure were independent risk factors in this study.