右美托咪定在姑息治疗中的应用:对抗谵妄和疼痛的多功能新武器--系统综述。

IF 2.2 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Journal of palliative medicine Pub Date : 2024-10-01 Epub Date: 2024-05-21 DOI:10.1089/jpm.2023.0609
Teresa Tavares, Joana Almeida, Edna Gonçalves, Fernando Abelha
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引用次数: 0

摘要

简介在生命的最后阶段,谵妄和疼痛的发生率很高。目前的治疗效果并不理想。右美托咪定可用于控制谵妄和疼痛,但在重症监护环境之外尚未获得批准。我们的目标是评估现有文献中有关右美托咪定在重症监护室以外的姑息治疗患者中控制疼痛和谵妄的疗效及其安全性的证据。本系统性综述在 PROSPERO 上进行了前瞻性注册,并进行了偏倚风险评估。方法:查阅了 PubMed 和 SCOPUS 上截至 2023 年发表的文献。如果实验、队列、横断面、病例对照研究和病例系列/报告评估了右美托咪定在住院姑息治疗成人患者谵妄和/或疼痛管理中的应用,则纳入这些研究。如果研究是在重症监护病房进行的,则排除在外。结果:在最初的 529 份记录中,有 14 份被纳入。虽然只有两项研究是随机试验,但大多数研究规模较小,只有一项研究的偏倚风险较低。在大多数病例报告和两项回顾性队列研究中,右美托咪定似乎是治疗这些症状的更好选择,尽管在随机试验中差异并不显著。讨论:右美托咪定似乎是治疗难治性疼痛和谵妄的一种很有前途的选择,可能有助于减少用于控制疼痛的阿片类药物用量。这是首次对右美托咪定在姑息治疗中的应用进行系统回顾。高质量的证据有限,但右美托咪定的临床特性证明在姑息治疗中进行对照试验是合理的。
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Dexmedetomidine in Palliative Care: A Versatile New Weapon Against Delirium and Pain-Systematic Review.

Introduction: At the end of life, the prevalence of delirium and pain is high. Current therapy is not satisfactory. Dexmedetomidine could be useful in the control of delirium and pain but is not approved outside of intensive care setting. Our objectives are to evaluate existing evidence in the literature that assessed the efficacy of dexmedetomidine in pain and delirium control and its safety in palliative care patients outside intensive care units. This systematic review was prospectively registered with PROSPERO and included a risk of bias assessment. Methods: PubMed and SCOPUS were examined for literature published until 2023. Experimental, cohort, cross-sectional, case-control studies, and case series/reports were included if they evaluate the use of dexmedetomidine in delirium and/or pain management in hospitalized palliative care adult patients. Studies were excluded if they were carried out in intensive care units. Results: Of the initial 529 records, 14 were included. Although only two studies were randomized trials, most were small and only one had low risk of bias. In most case reports and in the two retrospective cohort studies, dexmedetomidine appears to be a better option for these symptoms, although differences were not significant in the randomized trials. Discussion: Dexmedetomidine seems to be a promising option for refractory pain and delirium and may contribute to a reduction in opioid administration to control pain. This is the first systematic review of dexmedetomidine in palliative care. Quality evidence is limited, but clinical properties of dexmedetomidine justify the conduction of controlled trials in palliative care.

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来源期刊
Journal of palliative medicine
Journal of palliative medicine 医学-卫生保健
CiteScore
3.90
自引率
10.70%
发文量
345
审稿时长
2 months
期刊介绍: Journal of Palliative Medicine is the premier peer-reviewed journal covering medical, psychosocial, policy, and legal issues in end-of-life care and relief of suffering for patients with intractable pain. The Journal presents essential information for professionals in hospice/palliative medicine, focusing on improving quality of life for patients and their families, and the latest developments in drug and non-drug treatments. The companion biweekly eNewsletter, Briefings in Palliative Medicine, delivers the latest breaking news and information to keep clinicians and health care providers continuously updated.
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