重症监护病房中谵妄的病理生理学

Pathophysiology of delirium in the intensive care unit.

作者信息

Gunther Max L, Morandi Alessandro, Ely E Wesley

机构信息

VA Tennessee Valley Geriatric Research, Education and Clinical Center, Nashville, TN 37212-2637, USA.

出版信息

Crit Care Clin. 2008 Jan;24(1):45-65, viii. doi: 10.1016/j.ccc.2007.10.002.

DOI:10.1016/j.ccc.2007.10.002

PMID:18241778

Abstract

Delirium, or acute brain dysfunction, is a life-threatening global disturbance in cognitive functioning that frequently manifests in critically ill patients. This review examines the current status of knowledge regarding the pathophysiology of delirium in the ICU, in particular, evaluating the role of iatrogenic factors such as sedatives and analgesic administration in brain dysfunction. This hypothesis is considered along with several other plausible mechanisms of ICU delirium, including sepsis, postoperative cognitive dysfunction, and changes in biomarkers and neurotransmitters. The review concludes by highlighting potential future directions in molecular genetics for the elucidation of delirium and its long-term consequences.

摘要

谵妄，即急性脑功能障碍，是一种危及生命的认知功能全面紊乱，在危重症患者中经常出现。本综述探讨了关于重症监护病房（ICU）谵妄病理生理学的当前知识状况，特别是评估诸如镇静剂和镇痛药的使用等医源性因素在脑功能障碍中的作用。该假说与ICU谵妄的其他几种可能机制一同被考虑，包括脓毒症、术后认知功能障碍以及生物标志物和神经递质的变化。综述最后强调了分子遗传学在阐明谵妄及其长期后果方面未来可能的潜在方向。