Postoperative delirium: risk factors and management: Continuing Professional Development
Postoperative delirium: risk factors and management: Continuing Professional Development
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DOI：
10.1007/s12630-011-9658-4
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发表时间：
2012-03-01
影响因子：
4.2
通讯作者：
Bryson, Gregory L.
中科院分区：
文献类型：
--
作者：
Chaput, Alan J.;Bryson, Gregory L.
目的术后神志不清常常得不到诊断，因此得不到治疗。这一持续专业发展单元的目的是确定非心脏手术后出现精神错乱的高风险患者，并提供工具帮助诊断床边的精神错乱。推荐了最佳的预防和治疗策略。主要发现妄想症的特征是起病急，病程波动，注意力不集中，思维混乱，意识水平改变，在围手术期高达40%的患者会发生妄想症。精神错乱的病理生理学是多因素的，但它被认为与炎症、神经传递改变和接受手术的患者的压力有关。乙酰胆碱和多巴胺似乎扮演着重要的角色。在发展为精神错乱的患者中，预后不良的风险增加，包括住院时间更长和死亡。手术和患者因素在预测谁会随后发展为神志不清方面起着重要作用。在精神错乱的管理中，预防比治疗有效得多。最有效的预防战略包括积极主动的老年评估和在老年外科病房对患者的护理，以及预防性的低剂量抗精神病药物。从麻醉的角度来看，在一些外科手术人群中的证据将支持使用区域技术和最小限度的镇静。如果出现妄想症，小剂量口服抗精神病药物的治疗似乎是最有效的。结论妄想症是一种严重的疾病，必须及早认识并及时治疗，以减少有害后果。为了制定预防策略，并在病情发生时有效地进行治疗，麻醉师必须警惕地识别有风险的患者并筛查这种状况。
Purpose Postoperative delirium often remains undiagnosed and therefore untreated. The purpose of this continuing professional development module is to identify patients at high risk of developing delirium following non-cardiac surgery and to provide tools to aid in the diagnosis of delirium at the bedside. Optimal prevention and treatment strategies are recommended.Principal findings Delirium is characterized by an acute onset and a fluctuating course, inattention, disorganized thinking and an altered level of consciousness, and occurs in up to 40% of patients in the perioperative period. The pathophysiology of delirium is multifactorial, but it is believed to be related to inflammation, altered neurotransmission, and stress in the patient who has had surgery. Acetylcholine and dopamine appear to play a significant role. There is an increased risk of a poor outcome in patients who develop delirium, including a longer hospital stay and death. Surgical and patient factors play a significant role in predicting who will subsequently develop delirium. Prevention is much more effective than treatment in the management of delirium. The most effective prevention strategies include proactive geriatric assessment and care of the patient on a geriatrics surgical ward as well as prophylactic low-dose antipsychotic agents. From an anesthetic perspective, evidence in some surgical populations would support the use of regional techniques and minimal sedation. If delirium develops, treatment with low-dose oral antipsychotics appears to be most effective.Conclusions Delirium is a serious condition that must be recognized early and treated promptly to minimize deleterious outcomes. In order to institute prevention strategies and treat the condition effectively when it occurs, the anesthesiologist must be vigilant in identifying patients at risk and in screening for this condition.