Donepezil in the prevention and treatment of post-surgical delirium
Donepezil in the prevention and treatment of post-surgical delirium
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DOI：
10.1176/appi.ajgp.13.12.1100
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发表时间：
2005-12-01
影响因子：
7.2
通讯作者：
Krushell, R
中科院分区：
文献类型：
--
作者：
Liptzin, B;Laki, A;Krushell, R
目的：妄想是老年人大手术的常见并发症。作者评价了多奈哌齐与安慰剂在预防和治疗非痴呆性老年人群择期全关节置换术后精神障碍方面的益处。方法：随机、双盲、安慰剂对照的80名患者参与试验。每个参与者在手术前进行评估，然后在手术前和手术后14天接受多奈哌齐或安慰剂治疗。采用妄想症状访谈法、精神错乱评定法、日常病历、护士观察回顾和DSM-IV精神障碍诊断标准对术后精神障碍进行评估。结果：根据DSM-IV诊断标准，18.8%的受试者在术后至少1天内出现妄想，但多奈哌齐组和安慰剂组之间的差异无统计学意义。出现精神错乱时，仅持续1天，两组间无差异。68.8%的受试者在术后至少1天出现亚综合征妄想，当这种情况发生时，平均持续2天或更短时间。两组之间在亚综合征性妄想的发生或持续时间上没有差异。结论：在接受择期骨科手术的相对年轻且认知功能正常的老年患者中，这项先导性研究不能证明多奈哌齐在预防或治疗神志不清方面的益处。此外，术后精神错乱在该人群中并不是一个主要问题。
Objective: Delirium is a frequent complication of major surgery in older persons. The authors evaluated the possible benefit of donepezil versus placebo in the prevention and treatment of postoperative delirium in an older population without dementia undergoing elective total joint-replacement surgery.Methods: A sample of 80 patients participated in this randomized, double-blind, placebo-controlled trial of donepezil. Each participant was evaluated before surgery and then received donepezil or placebo for 14 days before surgery and 14 days afterward. Postoperative delirium was assessed with the Delirium Symptom Interview, Confusion Assessment Method, daily medical record, nurse-observation reviews, and DSM-IV diagnostic criteria for delirium. Subsyndromal delirium was also assessed for each participant.Results: Delirium, diagnosed by DSM-IV criteria, was found on at least 1 postoperative day in 18.8% of subjects, but there were no significant differences between the donepezil and placebo groups. When delirium was present, it lasted only 1 day, and there was no difference between the groups. Subsyndromal delirium was found on at least 1 postoperative day for 68.8% of subjects, and, when this occurred, lasted 2 days or less, on average. There was no difference between the groups in the occurrence or duration of subsyndromal delirium. There was no difference between the groups in disposition to home or to another facility.Conclusions: This pilot study was unable to demonstrate a benefit for donepezil in preventing or treating delirium in a relatively young and cognitively-intact group of elderly patients undergoing elective orthopedic surgery. Furthermore, postoperative delirium was not a major problem in this population.