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首页> 外文期刊>The Canadian journal of hospital pharmacy. >A Study to Determine the Pharmacological Management of Delirium in the Cardiovascular Intensive Care Unit
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A Study to Determine the Pharmacological Management of Delirium in the Cardiovascular Intensive Care Unit

机译：确定心血管重症监护史中谵妄药理管理的研究

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Background: Delirium is a recognized post-operative adverse event whose significance has intensified due to effects on morbidity and mortality. Currently, the rate of delirium post cardiac surgery in the cardiovascular intensive care unit (CVICU) at our institution is unknown and the pharmacological treatment modalities are not standardized and vary greatly. Objective: To determine the rate of delirium, the presence of risk factors that may predict the development of delirium and pharmacological treatment modalities used in post- operative cardiovascular surgery patients admitted to the CVICU. Methods: In this retrospective chart review, all patients undergoing cardiovascular surgery from April 1 to December 31,2014 were reviewed. Differences between patients were analyzed using Chi-square analysis. Results: The review included 420 patients of which 17% (n=73) developed delirium post-cardiovascular surgery in the CVICU. No significant differences were found between groups with respect to pre-operative co-morbidities and the development of delirium. Of those who became delirious, 83.6% (n=61) received a pharmacological agent for the treatment of delirium, with 52.5% (n=32) receiving 1 medication, 31.1% (n=19) receiving 2 and 16.4% (n=10) receiving 3 or more medications. Haloperidol was most commonly used (82%) followed by quetiapine (60.7%) and dexmedetomidine (13.1%). Those who experienced delirium had significantly greater exposure to sedatives including midazolam (57.5 vs 17.3%, p<0.00001), lorazepam (26 vs 1.4%, p<0.00001) and zopiclone (26 vs 6%, p<0.00001). No differences in mortality were found however length of CVICU stay was significantly longer in delirious patients (5.7 vs 1.8 days, p<0.00001). Conclusions: Delirium can commonly develop post cardiovascular surgery in the CVICU and it is difficult to predict who will develop it based on preoperative comorbidities. Therefore, the development of strategies to prevent delirium and to optimize pharmacological management is warranted.
机译：背景：谵妄是一个公认的术后不良事件，其意义由于对发病率和死亡率的影响而加剧。目前，在我们机构的心血管重症监护室（CVICU）中的谵妄后心脏手术率未知，药理学治疗方式没有标准化并变化很大。目的：确定谵妄的速度，可能预测患有术后心血管手术患者的谵妄和药理治疗方式的发展的危险因素的存在。方法：在此回顾性图表审查中，综述了从4月1日至12月31日前经历心血管外科的患者进行了审查。使用Chi-Square分析分析患者之间的差异。结果：综述包括420名患者，其中17％（n = 73）在CVICU中开发谵妄后心血管手术。在患有前的共同生命和谵妄的发展中，团体之间没有发现显着差异。对于那些变得令人惊讶的人，83.6％（n = 61）接受了治疗谵妄的药理学剂，52.5％（n = 32）接受1药物，31.1％（n = 19）接受2和16.4％（n = 10）接受3种或更多药物。氟哌啶醇最常用（82％），然后是喹硫胺（60.7％）和Dexmedetomidine（13.1％）。那些经历谵妄的人暴露于包括咪达唑仑（57.5 Vs17.3％，P <0.00001），Lorazepam（26 Vs 1.4％，P <0.00001）和唑啉（26 Vs 6％，P <0.00001）。发现死亡率没有差异，然而CVICU住院的长度在恶情患者中明显更长，但5.7 Vs 1.8天，P <0.00001）。结论：谵妄通常可以在CVICU中常见于心血管外科手术，难以预测谁将基于术前共聚物发展。因此，有必要制定防止谵妄和优化药理管理的策略。

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