Delirium onset related to autonomic nervous system disorder caused by aging, illness and/or the environment (noise, blue-ray)

谵妄患者的住院时间和死亡率明显高于非谵妄患者。据报道，腹主动脉瘤患者术后谵妄发作的发生率较高。入住重症监护室（ICU）的患者有时也会出现谵妄。病人暴露在一个紧张的环境中;他们与家人隔离，他们的睡眠被持续的噪音和灯光干扰。我们的调查显示，噪音在重症监护室明显高于在普通病房，并没有昼夜变化。在本研究中，腹主动脉瘤后开腹ICU患者被随机分为两组：一组使用耳塞;对照组不使用耳塞。通过无创测量心率和自主神经系统活动（ANS）及其昼夜变化来评估ICU住院期间ICU环境（噪音）引起的压力。在ICU患者中，谵妄和/或躁动从未戴耳塞的50%降至27%。在ANS和HR的昼夜节律消失或逆转的ICU患者中观察到谵妄和/或激越，HR的昼夜节律在ICU病房护理后从不规则恢复，而ANS甚至在5天后也没有恢复。结果表明，ICU患者夜间使用耳塞可减少谵妄和/或躁动的发作，这意味着来自ICU背景噪音的噪音在谵妄发作中起作用。

Length of hospital stay and mortality rates are significantly higher in delirium patients than in non-delirium patients. A high incidence of postoperative delirium onset has been reported among abdominal aortic aneurysm patients. Patients admitted to the intensive care unit (ICU) also sometimes experience a condition of delirium. The patients are exposed to an stressful environment; they are isolated from their families, and their sleep is disrupted by continuous noise and lighting. Our investigation revealed that noise in the ICU was markedly higher than in the general wards and there were no circadian variations. In the present study, postabdominal aortic aneurysm laparotomy ICU-patients were randomly divided into two groups: a group using earplugs; and a control group without earplugs. Stress caused by the ICU environment (noise) during ICU stay was assessed by non-invasive measurement of heart rate and autonomic nervous system activity (ANS) and their circadian variations. Delirium and/or agitation decreased to 27% in the ICU patients fitted with earplugs from 50% in one without earplugs. Where delirium and/or agitation were observed in ICU patients whose circadian rhythms disappeared or reversed in their ANS and HR, the circadian rhythm in the HR recovered from irregularity in post-ICU ward care, while the ANS did not recover even5 days later. The results indicate that nighttime use of earplugs in the ICU patients reduces onset of delirium and/or agitation, implying that noise from the ICU backgroundnoise plays a part in delirium onset.