Delirium and agitation in traumatic brain injury patients: an update on pathological hypotheses and treatment options
Delirium and agitation in traumatic brain injury patients: an update on pathological hypotheses and treatment options
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DOI：
10.23736/s0375-9393.18.12294-2
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发表时间：
2018-05-01
影响因子：
3.2
通讯作者：
Prisco, Lara
中科院分区：
文献类型：
--
作者：
Ganau, Mario;Lavinio, Andrea;Prisco, Lara
外伤性脑损伤（TBI）是一种全球性的公共卫生流行病。它是美国35岁以下个人死亡和残疾的主要原因。在亚急性期，恢复意识的严重TBI患者会经历躁动和谵妄的状态。然而，只有有限的研究探索创伤后谵妄（PTD）的特点，尽管它可能比一般的重症监护病房（ICU）患者更频繁。有证据表明，非创伤性脑损伤ICU患者谵妄的发生率高达86%。危重患者谵妄发生发展的病理生理机制尚不清楚。人们提出了许多假说：神经炎症、神经递质失衡、结构和功能性脑损伤。TBI患者创伤后认知障碍的风险很高，高达三分之二的TBI存活患者会出现躁动和谵妄，这与残疾增加和长期认知障碍有关。ICU收治的PTD患者的治疗建议尚不明确。尽管PTD的患病率很高，但这种情况经常被误解和归咎于。主要是伤口本身。越来越多的证据表明，某些药物如抗精神病药物可以降低谵妄的发生率和严重程度，而其他药物如右美托咪定和瑞芬太尼则与降低普通ICU患者发生谵妄的风险有关。然而，缺乏高质量的研究探索急性PTD的治疗策略。
Traumatic brain injury (TBI) is a global public health epidemic. It represents the principal cause of death and disability in individuals aged under 35 in the USA. In the subacute phase, severe TBI patients who recover consciousness go through a state of agitation and delirium. However, there is only limited research exploring the characteristics of post-traumatic delirium (PTD) although it is likely to be more frequent than in general Intensive Care Unit (ICU) patients. Evidence suggest the incidence of delirium in non-TBI ICU patients is up to 86%. The exact pathophysiological mechanisms underlying the development and progression of delirium in critically ill patients is still unclear. Many hypotheses have been proposed to play a role: neuroinflammation, neurotransmitter imbalance, structural and functional brain damage. TBI patients are at high risk of post-traumatic cognitive impairment, and up to two thirds of patients who survive TBI develop agitation and delirium which is associated with increased disability and long term cognitive impairment. Recommendation for the treatment of PTD in patients admitted to ICU are not clearly identified. Despite the high prevalence of PTD, the condition often goes misrecognized and attributed . primarily to the injury itself. There is increasing evidence that certain drugs such as antipsychotics can reduce the incidence and severity of delirium, whereas other drugs such as dexmedetomidine and remifentanil are associated with decreased risk of developing delirium in general ICU patients. However, there is a lack of high quality studies exploring treatment strategies for PTD in the acute setting.