Postoperative delirium: are there modifiable risk factors?
Postoperative delirium: are there modifiable risk factors?
复制标题
术后谵妄：是否有可改变的危险因素？
DOI：
10.1097/eja.0b013e3283340a99
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发表时间：
2010
影响因子：
3.6
通讯作者：
Leung,JacquelineM
中科院分区：
文献类型：
--
作者：
Leung,JacquelineM
精神错乱是一种急性混乱状态，伴有注意力和意识的变化。1妄想症发生在14%-50%的住院内科患者中，其相关死亡率为10%-65%。2、3非心脏大手术后，10-60%的患者出现妄想。4妄想症是住院老年患者的一个严重问题。它可能是由潜在的疾病引起的，但通常情况下，确切的原因无法确定。5精神错乱的过程可能有很大的不同，取决于致病因素的解决。从经济角度来看，术后精神错乱构成了一项重大的医疗支出，使每个患者增加了近4000美元的成本。6最近的一项研究类似地报告，在重症监护病房出现精神错乱的患者的医疗费用比没有精神错乱的患者高出31%(41836美元对27105美元)。7这些对精神错乱的费用和负担的描述甚至不包括与安置疗养院相关的费用以及家庭的经济和心理负担。了解术后精神错乱的病理生理学对于制定管理策略以减少其发生至关重要。精神错乱的发展被认为是一个多因素的过程，在这个过程中，基线患者的脆弱性与诱发因素或侮辱之间存在复杂的相互关系。8在围手术期，导致老年患者术后精神错乱的潜在危险因素包括疼痛、手术压力(如失血和/或血流动力学变化)、不动、睡眠障碍以及接触阿片类药物和苯二氮卓类药物，这些药物可能对中枢神经系统产生深远影响。这一期的《欧洲麻醉学杂志》包含了一项研究，表明术后精神错乱的另外两个诱发危险因素实际上可能是医源性的，而且有可能是可以预防的。9.
Delirium is an acute confusional state with alterations in attention and consciousness. 1 Delirium occurs in 14–50% of hospitalized medical patients and its associated mortality rate is 10–65%. 2, 3 After major noncardiac surgery, 10–60% of patients have delirium. 4 Delirium is a serious problem for hospitalized geriatric patients. It may be caused by an underlying medical illness, but often, the exact cause is not identifiable. 5 The course of delirium can vary considerably and depends on resolution of the causative factors. From an economic standpoint, postoperative delirium constitutes a significant healthcare expenditure adding nearly $4000 in costs per patient. 6 A recent study similarly reported that healthcare costs in patients who developed delirium in the intensive care unit were 31% higher than those without delirium ($41 836 versus $27 105). 7 These descriptions of the costs and burden of delirium do not even include the costs associated with nursing home placement and the economic and psychological burden to the family.Understanding the pathophysiology of postoperative delirium is critical to allow the development of management strategies to reduce its occurrence. The development of delirium is thought to be a multifactorial process in which there is a complex interrelationship between baseline patient vulnerability and precipitating factors or insults. 8 In the perioperative period, the potential precipitating risk factors for the development of postoperative delirium in older patients include pain, stress of surgery such as blood loss and/or haemodynamic changes, immobility, sleep disturbance, and exposure to medications such as opioids and benzodiazepines that have the potential for profound effects on the central nervous system. This issue of the European Journal of Anaesthesiology contains a study suggesting that two additional precipitating risk factors for postoperative delirium may actually be iatrogenic and potentially preventable. 9