Delirium in the cardiac surgical ICU.
Delirium in the cardiac surgical ICU.
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DOI：
10.1097/aco.0000000000000061
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发表时间：
2014-04
期刊：
影响因子：
--
通讯作者：
Brown CH
中科院分区：
文献类型：
--
作者：
Brown CH
有证据表明，谵妄与短期和长期的发病率和死亡率有关。本文综述了心脏手术后谵妄的流行病学、预后、预防和治疗策略。心脏手术后谵妄的发生率估计为26- 52%，其中显著百分比为活动减退性谵妄。很明显，如果没有一个适当的结构化测试谵妄，谵妄的发生率将在临床上认识不足。心脏手术后谵妄与不良结局相关，包括长期死亡率增加、卒中风险增加、功能状态不良、再入院率增加和术后1年的严重认知功能障碍。预防性抗精神病药物降低谵妄风险的有效性存在争议，最近在非心脏手术中进行的小型研究的数据可能显示出获益。虽然抗精神病药物常用于治疗谵妄，但抗精神病药物用于心脏手术患者减少谵妄持续时间或改善谵妄后长期结局的证据不足。ICU的临床医生必须认识到谵妄对预测患者长期预后的影响。需要进一步的研究来确定有效预防和治疗心脏手术中谵妄的干预措施。
Evidence is emerging that delirium is associated with both short- and long-term morbidity and mortality. This review highlights the epidemiology, outcomes, prevention and treatment strategies associated with delirium after cardiac surgery. The incidence of delirium after cardiac surgery is estimated to be 26-52%, with a significant percentage being hypoactive delirium. It is clear that without an appropriate structured test for delirium, the incidence of delirium will be under-recognized clinically. Delirium after cardiac surgery is associated with poor outcomes including increased long-term mortality, increased risk of stroke, poor functional status, increased hospital readmissions, and substantial cognitive dysfunction for 1-year following surgery. The effectiveness of prophylactic antipsychotics to reduce the risk of delirium is controversial, with data from recent small studies in non-cardiac surgery potentially showing a benefit. Although anti-psychotic medications are often used to treat delirium, the evidence that anti-psychotics in cardiac surgery patients reduce duration of delirium or improve long-term outcomes following delirium is poor. Clinicians in the ICU must recognize the impact of delirium in predicting long-term outcomes for patients. Further research is needed in determining interventions that will be effective in preventing and treating delirium in cardiac surgical setting.