切换至 "中华医学电子期刊资源库"

中华危重症医学杂志(电子版) ›› 2020, Vol. 13 ›› Issue (03) : 200 -206. doi: 10.3877/cma.j.issn.1674-6880.2020.03.008

所属专题: 文献

荟萃分析

氟哌啶醇预防危重症患者谵妄发生的Meta分析
王倩1, 赵阳2,(), 臧彬2   
  1. 1. 110000 沈阳,中国医科大学附属盛京医院ICU(现工作单位为中国医科大学附属第四医院急诊科)
    2. 110000 沈阳,中国医科大学附属盛京医院ICU
  • 收稿日期:2019-12-25 出版日期:2020-06-01
  • 通信作者: 赵阳

Preventive effect of haloperidol on delirium in critically ill patients: a meta-analysis

Qian Wang1, Yang Zhao2,(), Bin Zang2   

  1. 1. Department of Intensive Care Unit, Shengjing Hospital of China Medical University, Shengyang 110000, China (Wang Qian, currently working in the Department of Emergency Medicine, the Fourth Affiliated Hospital of China Medical University)
    2. Department of Intensive Care Unit, Shengjing Hospital of China Medical University, Shengyang 110000, China
  • Received:2019-12-25 Published:2020-06-01
  • Corresponding author: Yang Zhao
  • About author:
    Corresponding author: Zhao Yang, Email:
引用本文:

王倩, 赵阳, 臧彬. 氟哌啶醇预防危重症患者谵妄发生的Meta分析[J/OL]. 中华危重症医学杂志(电子版), 2020, 13(03): 200-206.

Qian Wang, Yang Zhao, Bin Zang. Preventive effect of haloperidol on delirium in critically ill patients: a meta-analysis[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2020, 13(03): 200-206.

目的

系统评价氟哌啶醇预防危重患者发生谵妄的疗效和安全性。

方法

计算机检索Medline、EMbase、The Cochrane Library、维普数据库、中国知网、中国生物医学文献数据库数据库从建库至2018年9月的关于氟哌啶醇预防危重症患者谵妄疗效的随机对照试验(RCT)。由2位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.2软件进行Meta分析。

结果

共纳入4个RCT,2 455例患者。Meta分析结果显示,试验组与对照组危重症患者间28 d谵妄发病率[相对危险度(RR) = 0.96,95%置信区间(CI)(0.65,1.43),Z = 0.19,P = 0.85]、28 d无谵妄及无昏迷时间[均数差(MD) = 0.05,95%CI(-0.06,0.15),Z = 0.88,P = 0.38]、28 d存活率[RR = 1.00,95%CI(0.97,1.04),Z = 0.23,P = 0.82]、ICU住院时间[MD = -0.18,95%CI(-2.00,1.64),Z = 0.20,P = 0.84]的比较,差异均无统计学意义。且在严重不良反应方面,两组患者间QTc间期延长[RR = 1.18,95%CI(0.83,1.67),Z = 0.92,P = 0.36]、锥体外系症状[RR = 1.07,95%CI(0.69,1.67),Z = 0.31,P = 0.76]、过度镇静[RR = 1.90,95%CI(0.77,4.66),Z = 1.40,P = 0.16]发生的比较,差异也均无统计学意义。

结论

氟哌啶醇不能预防危重症患者谵妄的发生,且对预后也没有明显改善作用。

Objective

To systemically evaluate the preventive effect of haloperidol on delirium in critically ill patients and its safety.

Methods

The Medline, EMbase, Cochrane Library, VIP, CNKI and CBM databases were searched for randomized controlled trials (RCTs) about the preventive effect of haloperidol on delirium in critically ill patients published up to September 2018. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software.

Results

Totally 4 RCTs involving 2 455 patients were included in this study. Meta-analysis showed that the 28-d delirium incidence [relative risk (RR) = 0.96, 95% confidence interval (CI) (0.65, 1.43), Z = 0.19, P = 0.85], delirium-free and coma-free days within 28 days [mean difference (MD) = 0.05, 95%CI (-0.06, 0.15), Z = 0.88, P = 0.38], 28-d survival rate [RR = 1.00, 95%CI (0.97, 1.04), Z = 0.23, P = 0.82] and ICU length of stay [MD = -0.18, 95%CI (-2.00, 1.64), Z = 0.20, P = 0.84] all showed no significant differences between the haloperidol group and control group. Moreover, there were no statistically significant differences in the QTc interval prolongation [RR = 1.18, 95%CI (0.83, 1.67), Z = 0.92, P = 0.36], extrapyramidal symptoms [RR = 1.07, 95%CI (0.69, 1.67), Z = 0.31, P = 0.76] and excessive sedation [RR = 1.90, 95%CI (0.77, 4.66), Z = 1.40, P = 0.16] between the two groups.

Conclusion

Haloperidol cannot prevent delirium in critically ill patients or improve their prognosis.

表1 纳入研究的基本特征
表2 纳入研究的方法学质量评价
图1 试验组(氟哌啶醇)与对照组(安慰剂)治疗对危重症患者谵妄发病率影响的森林图
图2 试验组(氟哌啶醇)与对照组(安慰剂)治疗对危重症患者28 d无谵妄及无昏迷时间影响的森林图
图3 试验组(氟哌啶醇)与对照组(安慰剂)治疗对危重症患者28 d存活率影响的森林图
图4 试验组(氟哌啶醇)与对照组(安慰剂)治疗对危重症患者ICU住院时间影响的森林图
图5 试验组(氟哌啶醇)与对照组(安慰剂)治疗对危重症患者严重不良反应影响的森林图
图6 纳入研究的发表偏倚风险的漏斗图
1
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5)[M]. 5th ed. Arlington, VA: American Psychiatric Publishing, 2013.
2
Reade MC, O'Sullivan K, Bates S, et al. Dexmedeto-midine vs. haloperidol in delirious, agitated, intubated patients: a randomised open-label trial[J]. Crit Care, 2009, 13 (3): R75.
3
Bledowski J, Trutia A. A review of pharmacologic management and prevention strategies for delirium in the intensive care unit[J]. Psychosomatics, 2012, 53 (3): 203-211.
4
Siddiqi N, Stockdale R, Britton AM, et al. Interventions for preventing delirium in hospitalised patients [J]. Cochrane Database Syst Rev, 2007, 18 (2): CD005563.
5
Girard TD, Pandharipande PP, Carson SS, et al. Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial[J]. Crit Care Med, 2010, 38 (2): 428-437.
6
Swan JT, Fitousis K, Hall JB, et al. Antipsychotic use and diagnosis of delirium in the intensive care unit [J]. Crit Care, 2012, 16 (3): R84.
7
van den Boogaard M, Schoonhoven L, van Achterberg T, et al. Haloperidol prophylaxis in critically ill patients with a high risk for delirium[J]. Crit Care, 2013, 17 (1): R9.
8
Pandharipande PP, Girard TD, Jackson JC, et al. Long-term cognitive impairment after critical illness[J]. N Engl J Med, 2013, 369 (14): 1306-1316.
9
Ely EW, Shintani A, Truman B, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit[J]. JAMA, 2004, 291 (14): 1753-1762.
10
Halpern NA. Can the costs of critical care be controlled?[J]. Curr Opin Crit Care, 2009, 15 (6): 591-596.
11
Gusmao-Flores D, Salluh JI, Chalhub RA, et al. The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies[J]. Crit Care, 2012, 16 (4): R115.
12
Devlin JW, Bhat S, Roberts RJ, et al. Current perceptions and practices surrounding the recognition and treatment of delirium in the intensive care unit: a survey of 250 critical care pharmacists from eight states[J]. Ann Pharmacother, 2011, 45 (10): 1217-1229.

URL    
13
Mac Sweeney R, Barber V, Page V, et al. A national survey of the management of delirium in UK intensive care units[J]. QJM, 2010, 103 (4): 243-251.
14
Trogrlic Z, Ista E, Slooter A, et al. Current practices in ICU delirium management: a prospective multicenter study in the Netherlands[J]. Crit Care, 2013, 17 (Suppl 2): P395.
15
Morandi A, Davis D, Taylor JK, et al. Consensus and variations in opinions on delirium care: a survey of European delirium specialists[J]. Int Psychogeriatr, 2013, 25 (12): 2067-2075.

URL    
16
Bellelli G, Morandi A, Zanetti E, et al. Recognition and management of delirium among doctors, nurses, physiotherapists, and psychologists: an Italian survey[J]. Int Psychogeriatr, 2014, 26 (12): 2093-2102.

URL    
17
Martin J, Heymann A, Basell K, et al. Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care--short version[J]. Ger Med Sci, 2010 (8): Doc02.
18
Page VJ, Ely EW, Gates S, et al. Effect of intravenous haloperidol on the duration of delirium and coma in critically ill patients (Hope-ICU): a randomised, double-blind, placebo-controlled trial[J]. Lancet Respir Med, 2013, 1 (7): 515-523.
19
Al-Qadheeb NS, Skrobik Y, Schumaker G, et al. Preventing ICU subsyndromal delirium conversion to delirium with low-dose IV haloperidol: a double-blind, placebo-controlled pilot study[J]. Crit Care Med, 2016, 44 (3): 583-591.
20
van den Boogaard M, Slooter AJC, Brüggemann RJM, et al. Effect of haloperidol on survival among critically ill adults with a high risk of delirium: the REDUCE randomized clinical trial[J]. JAMA, 2018, 319 (7): 680-690.
21
Wang W, Li HL, Wang DX, et al. Haloperidol prophylaxis decreases delirium incidence in elderly patients after noncardiac surgery: a randomized controlled trial[J]. Crit Care Med, 2012, 40 (3): 731-739.
22
Cavallazzi R, Saad M, Marik PE. Delirium in the ICU: an overview[J]. Ann Intensive Care, 2012, 2 (1): 49.
23
何珊,左泽兰. 镇静镇痛状态下危重症患儿谵妄评估研究进展[J/CD]. 中华危重症医学杂志(电子版),2018,11(1):55-59.

URL    
24
Wang EH, Mabasa VH, Loh GW, et al. Haloperidol dosing strategies in the treatment of delirium in the critically ill[J]. Neurocrit Care, 2012, 16 (1): 170-183.

URL    
25
Santos E, Cardoso D, Neves H, et al. Effectiveness of haloperidol prophylaxis in critically ill patients with a high risk of delirium: a systematic review[J]. JBI Database System Rev Implement Rep, 2017, 15 (5): 1440-1472.
26
Schrijver EJ, de Graaf K, de Vries OJ, et al. Efficacy and safety of haloperidol for in-hospital delirium prevention and treatment: a systematic review of current evidence[J]. Eur J Intern Med, 2016 (27): 14-23.
27
Yoon HJ, Park KM, Choi WJ, et al. Efficacy and safety of haloperidol versus atypical antipsychotic medications in the treatment of delirium[J]. BMC Psychiatry, 2013 (13): 240.
28
Boettger S, Friedlander M, Breitbart W, et al. Aripiprazole and haloperidol in the treatment of delirium [J]. Aust N Z J Psychiatry, 2011, 45 (6): 477-482.
29
Schwartz TL, Masand PS. Treatment of delirium with quetiapine[J]. Prim Care Companion J Clin Psychiatry, 2000, 2 (1): 10-12.
30
Barr J, Pandharipande PP. The pain, agitation, and delirium care bundle: synergistic benefits of implementing the 2013 pain, agitation, and delirium guidelines in an integrated and interdisciplinary fashion[J]. Crit Care Med, 2013, 41 (9 Suppl 1): S99-S115.
[1] 陈晓玲, 钟永洌, 刘巧梨, 李娜, 张志奇, 廖威明, 黄桂武. 超高龄髋膝关节术后谵妄及心血管并发症风险预测[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 575-584.
[2] 蚁淳, 袁冬生, 熊学军. 系统免疫炎症指数与骨密度降低和骨质疏松的关联[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 609-617.
[3] 李志文, 李远志, 李华, 方志远. 糖皮质激素治疗膝骨关节炎疗效的网状Meta分析[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 484-496.
[4] 吴姗姗, 潘裕民, 刘晋, 张劲松, 乔莉. 睡眠呼吸暂停综合征患者静脉血栓栓塞症发生率的Meta分析[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(04): 312-317.
[5] 沈皓, 张驰, 韩旻轩, 陆晓庆, 周愉, 周莉丽. 骨皮质切开术对正畸治疗牙根吸收影响的Meta分析[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(03): 175-184.
[6] 寇宛婷, 蔡英华, 周海琴, 吴琼. 肺移植术后谵妄影响因素的范围综述[J/OL]. 中华移植杂志(电子版), 2024, 18(04): 251-256.
[7] 朱俊佳, 孙琦, 徐文龙, 陆天宇, 冯强, 储涛, 邢春根, 高春冬, 俞一峰, 赵振国. 永久性结肠造口预防性补片置入对预防造口旁疝价值的Meta分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 336-342.
[8] 王招荐, 曹桢, 郭小双, 靳小雷, 刘子文. 加速康复外科理念应用于腹壁重建手术的系统评价及Meta分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(03): 343-350.
[9] 袁延丽, 屈卓军, 崔会慧, 王菁, 高贝贝, 潘院. 原发性肺癌切除术后谵妄的危险因素及预后分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 701-706.
[10] 马振威, 宋润夫, 王兵. ERCP胆道内支架与骑跨十二指肠乳头支架置入治疗不可切除肝门部胆管癌疗效的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 807-812.
[11] 龚财芳, 赵俊宇, 游川. 围手术期肠内营养在肝癌肝切除患者中有效性及安全性的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 551-556.
[12] 郁凯, 曾保起, 杨剑, 杨杰, 张殿英, 孙凤. 全关节镜与切开手术治疗肩袖撕裂疗效比较的系统综述与Meta分析[J/OL]. 中华肩肘外科电子杂志, 2024, 12(03): 238-245.
[13] 王芳, 刘达, 左智炜, 盛金平, 陈庭进, 蒋锐. 定量CT与双能X线骨密度仪对骨质疏松诊断效能比较的Meta分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 363-371.
[14] 郑以山, 颜骏, 刘军. 《ICU中成人急性肝衰竭和急性-慢性肝衰竭的管理指南:神经病学、围移植期医学、感染性疾病和胃肠病学注意事项》解读[J/OL]. 中华重症医学电子杂志, 2024, 10(03): 214-217.
[15] 周倩妹, 王宪娥, 徐筱, 老慧琳, 赵欣悦, 胡菁颖. 多元化系统护理对老年人群牙周健康指标影响的系统评价[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 500-506.
阅读次数
全文


摘要