■抗精神病药物通常用于治疗术后谵妄。最近的研究报告说,氟哌啶醇的使用已经下降,非典型抗精神病药物的使用随着时间的推移而增加。
为了比较与口服氟哌啶醇相关的院内不良事件的风险,奥氮平,喹硫平,和利培酮在老年患者大手术后。
■回顾性队列研究。
■PremierHealthcare数据库中的美国医院。
■从2009年到2018年,17115名65岁及以上无精神疾病的患者在大手术后服用了口服抗精神病药物。
■氟哌啶醇(起始当天≤4毫克),奥氮平(≤10mg),喹硫平(≤150mg),和利培酮(≤4毫克)。
■住院死亡的风险比(RR),心律失常事件,肺炎,在倾向评分重叠加权后估计卒中或短暂性脑缺血发作(TIA).
■加权人口的平均年龄为79.6岁,60.5%是女性,住院死亡率为3.1%。在4种抗精神病药物中,喹硫平的处方量最高(占总暴露量的53.0%).在使用氟哌啶醇治疗的患者中,院内死亡的风险没有统计学上的显着差异(3.7%,参考组),奥氮平(2.8%;RR,0.74[95%CI,0.42至1.27]),喹硫平(2.6%;RR,0.70[CI,0.47至1.04]),和利培酮(3.3%;RR,0.90[CI,0.53至1.41])。心律失常事件的非致死性临床事件的风险范围为2.0%至2.6%,肺炎的4.2%至4.6%,中风或短暂性脑缺血发作为0.6%至1.2%,治疗组差异无统计学意义。
■谵妄严重程度的残留混杂;缺乏未治疗组;限制口服中低剂量治疗。
■这些结果表明,非典型抗精神病药和氟哌啶醇在接受口服低剂量至中等剂量抗精神病药物的术后谵妄老年患者的院内不良临床事件发生率相似。
■国家老龄研究所。
Antipsychotics are commonly used to manage postoperative delirium. Recent studies reported that haloperidol use has declined, and atypical antipsychotic use has increased over time.
To compare the risk for in-hospital adverse events associated with oral haloperidol, olanzapine, quetiapine, and risperidone in older patients after major surgery.
Retrospective cohort
study.
U.S. hospitals in the Premier Healthcare Database.
17 115 patients aged 65 years and older without psychiatric disorders who were prescribed an oral antipsychotic drug after major surgery from 2009 to 2018.
Haloperidol (≤4 mg on the day of initiation), olanzapine (≤10 mg), quetiapine (≤150 mg), and risperidone (≤4 mg).
The risk ratios (RRs) for in-hospital death, cardiac arrhythmia events, pneumonia, and stroke or transient ischemic attack (TIA) were estimated after propensity score overlap weighting.
The weighted population had a mean age of 79.6 years, was 60.5% female, and had in-hospital death of 3.1%. Among the 4 antipsychotics, quetiapine was the most prescribed (53.0% of total exposure). There was no statistically significant difference in the risk for in-hospital death among patients treated with haloperidol (3.7%, reference group), olanzapine (2.8%; RR, 0.74 [95% CI, 0.42 to 1.27]), quetiapine (2.6%; RR, 0.70 [CI, 0.47 to 1.04]), and risperidone (3.3%; RR, 0.90 [CI, 0.53 to 1.41]). The risk for nonfatal clinical events ranged from 2.0% to 2.6% for a cardiac arrhythmia event, 4.2% to 4.6% for pneumonia, and 0.6% to 1.2% for stroke or TIA, with no statistically significant differences by treatment group.
Residual confounding by delirium severity; lack of untreated group; restriction to oral low-to-moderate dose treatment.
These results suggest that atypical antipsychotics and haloperidol have similar rates of in-hospital adverse clinical events in older patients with postoperative delirium who receive an oral low-to-moderate dose antipsychotic drug.
National Institute on Aging.