抗精神病药经常用于治疗末期谵妄症状，但证据有限。 旨在探讨氟哌啶醇与按需苯二氮卓类药物 (HPD) 与氯丙嗪 (CPZ) 与左美丙嗪 (LPZ) 对于最后几天的躁动性谵妄的比较疗效.在日本的两个姑息治疗中心进行了一项前瞻性观察研究。患有躁动性谵妄的成年癌症患者，其改良的里士满躁动-镇静量表（RASS-PAL）为一项或多项；姑息治疗专科医生确定病因是不可逆转的；预计生存时间为 3 周或更短。对接受 HPD、CPZ 或 LPZ 治疗的患者进行了分析。我们在第 1 天和第 3 天测量了 RASS、NuDESC、激越应激量表 (ADS) 和沟通能力量表 (CCS)。 共有 277 名患者入组，并对 214 名患者进行了分析（HPD 中 112 名，CPZ 中 50 名，CPZ 中 52 名）。 LPZ）。在所有组中，平均 RASS-PAL 评分在第 3 天均显着下降（分别为 1.37 至 -1.01、1.87 至 -1.04、1.79 至 -0.62；P < 0.001）； NuDESC 和 ADS 分数也显着下降。第3天出现中度至重度躁动的患者和具有完全沟通能力的患者的百分比没有显着差异。治疗耐受性良好。虽然四分之一的 HPD 组更换了抗精神病药物，但 88% 或更多的 CPZ 和 LPZ 组继续使用最初的抗精神病药物。氟哌啶醇与按需苯二氮卓类药物、氯丙嗪或左旋美丙嗪治疗末期躁动可能是有效且安全的。氯丙嗪和左美丙嗪可能具有无需更换药物的优势。版权所有 © 2024 美国临终关怀和姑息医学学会。由爱思唯尔公司出版。保留所有权利。

Antipsychotics are often used in managing symptoms of terminal delirium, but evidence is limited.To explore the comparative effectiveness of haloperidol with as-needed benzodiazepines (HPD) vs. chlorpromazine (CPZ) vs. levomepromazine (LPZ) for agitated delirium in the last days.A prospective observational study was conducted in two palliative care units in Japan. Adult cancer patients who developed agitated delirium with a modified Richmond Agitation-Sedation Scale (RASS-PAL) of one or more were included; palliative care specialist physicians determined that the etiology was irreversible; and estimated survival was 3 weeks or less. Patients treated with HPD, CPZ, or LPZ were analyzed. We measured RASS, NuDESC, Agitation Distress Scale (ADS), and Communication Capacity Scale (CCS) on Days 1 and 3.A total of 277 patients were enrolled, and 214 were analyzed (112 in HPD, 50 in CPZ, and 52 in LPZ). In all groups, the mean RASS-PAL score significantly decreased on Day 3 (1.37 to -1.01, 1.87 to -1.04, 1.79 to -0.62, respectively; P < 0.001); the NuDESC and ADS scores also significantly decreased. The percentages of patients with moderate to severe agitation and those with full communication capacity on Day 3 were not significantly different. The treatments were well-tolerated. While one-fourth of HPD group changed antipsychotics, 88% or more of CPZ and LPZ groups continued the initial antipsychotics.Haloperidol with as-needed benzodiazepine, chlorpromazine, or levomepromazine may be effective and safe for terminal agitation. Chlorpromazine and levomepromazine may have an advantage of no need to change medications.Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.