右美托咪定联合齐拉西酮治疗不同分型ICU谵妄的随机对照试验

Dexmedetomidine combined with ziprasidone in treating different subtypes of ICU delirium:a randomized controlled trial

目的探讨右美托咪定联合齐拉西酮治疗不同分型ICU谵妄患者的临床疗效及安全性。方法采用前瞻性随机对照研究方法,将60例ICU谵妄患者分为对照组和试验组,每组30例。对照组给予右美托咪定负荷剂量0.5~1.0μg·kg^(-1)静脉泵注15 min,后以0.2~0.7μg·kg^(-1)·h^(-1)持续静脉泵入,至患者谵妄状态好转;试验组在对照组的基础上加用齐拉西酮,起始剂量15 mg肌内注射,依据病情需要可再次给药,最大剂量不超过40 mg·d^(-1),最多干预3 d。观察患者的谵妄持续时间、用药后ICU停留时间、治疗前后简易精神状态检查(MMSE)和急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分,及不良反应发生情况。进一步分析试验组各型(亢进型、抑制型、混合型)谵妄患者的齐拉西酮使用总量、谵妄持续时间、ICU停留时间、MMSE和APACHEⅡ评分。结果试验组谵妄持续时间、用药后ICU停留时间均显著短于对照组(P<0.05);试验组中亢进型患者的齐拉西酮使用总量和谵妄持续时间、用药后ICU停留时间均显著短于抑制型、混合型患者(P<0.05)。治疗后第1、2、3日试验组MMSE评分均显著高于对照组(P<0.05),治疗后第3日试验组APACHEⅡ评分显著低于对照组(P<0.05);治疗后第3日混合型患者的MMSE评分显著低于亢进型和抑制型患者,APACHEⅡ评分显著高于亢进型和抑制型患者(P<0.05)。试验组心动过缓发生率低于对照组(3%vs.27%,P<0.05)。结论右美托咪定联合齐拉西酮治疗ICU谵妄患者的临床疗效确切且安全,对亢进型谵妄患者的疗效更优。

AIM To explore the clinical efficacy and safety of dexmedetomidine combined with ziprasidone in the treatment of patients with different subtypes of ICU delirium.METHODS This was a prospective randomized controlled trial study.A total of 60 patients with ICU delirium were randomly divided into control group and trial group,30 cases in each group.The patients in the control group were treated with dexmedetomidine 0.5-1.0μg·kg^(-1) loading dose intravenously in 15 min,and followed by a continuous infusion of 0.2-0.7μg·kg^(-1)·h^(-1)via infusion pump until delirium was improved.On the basis of the control group,the patients in the trial group were added with ziprasidone 15 mg initial dose intramuscularly.which could be repeated intramuscular injection according to the condition,with a maximum less than 40 mg·d^(-1) and the duration of intervention less than 3 days.The duration of delirium,ICU length of stay after administration,scores of mini-mental state examination(MMSE)and acute physiology and chronic health evaluation II(APACHE I)both before and after treatment,and the adverse drug reactions were observed.The total dose of ziprasidone,duration of delirium,ICU length of stay after administration,MMSE scores and APACHE II scores of patients with delirium of diferent types(hypoactive,hyperactive,and mixed type)in the trial group were further analyzed.RESULTS The duration of delirium and ICU length of stay after administration in the trial group were lower than those in the control group(P<0.05).The total dose of ziprasidone,the duration of delirium and ICU length of stay after administration in hyperactive delirium patients were lower than those in hypoactive and mixed delirium patients(P<0.05).MMSE scores in the trial group were higher than those in the control group on the Ist,2nd and 3rd day after treatment(P<0.05),and APACHE II scores in the trial group were lower than those in the control group on the 3rd day after treatment(P<0.05).The MMSE scores in mixed delirium patients were lower than those in hyperactive and hypoactive delirium patients(P<0.05)on the 3rd day after treatment,and APACHE II scores were higher than those in hyperactive and hypoactive delirium patients(P<0.05).The incidence of bradycardia in the trial group was lower than that in the control group(3%vs.27%,P<0.05).CONCLUSION The clinical efficacy of dexmedetomidine combined with ziprasidone in the treatment of ICU delirium patients is accurate and safe,which is more excellent in hyperactive delirium patients.