Sieber Frederick E
Department of Anesthesiology, Johns Hopkins Bayview Medical Center, Johns Hopkins Medical Institutions, Baltimore, MD 21224, USA.
Anesthesiol Clin. 2009 Sep;27(3):451-64, table of contents. doi: 10.1016/j.anclin.2009.07.009.
Delirium is a common complication in the geriatric population following cardiac and noncardiac procedures. Postoperative delirium is a significant financial burden on the United States health care system and is independently associated with prolonged hospital stay, increased risk of early and long term mortality, increased physical dependence, and an increased rate of nursing home placement. The Confusion Assessment Method (CAM) is a bedside rating scale developed to assist nonpsychiatrically trained clinicians in the rapid and accurate diagnosis of delirium. The CAM has been adapted for use in ventilated intensive care unit (ICU) patients in the form of the CAM-ICU. The onset of delirium involves an interaction between predisposing and precipitating risk factors for delirium. The mainstay of delirium management is prevention. The approach involves control or elimination of modifiable risk factors. It is controversial whether anesthetic technique determines delirium. However, important modifiable risk factors under the anesthesiologist's control include adequate postoperative pain management, careful drug selection, and embracing and participating in a multidisciplinary care model for these complicated patients.
谵妄是老年人群在心脏和非心脏手术后常见的并发症。术后谵妄给美国医疗保健系统带来了巨大的经济负担，并且与住院时间延长、早期和长期死亡风险增加、身体依赖增加以及入住疗养院的比率上升独立相关。谵妄评估方法（CAM）是一种床边评定量表，旨在帮助未经精神科培训的临床医生快速、准确地诊断谵妄。CAM已改编成适用于机械通气重症监护病房（ICU）患者的形式，即CAM-ICU。谵妄的发生涉及谵妄易感风险因素和促发风险因素之间的相互作用。谵妄管理的主要手段是预防。该方法包括控制或消除可改变的风险因素。麻醉技术是否决定谵妄存在争议。然而，在麻醉医生控制下的重要可改变风险因素包括充分的术后疼痛管理、谨慎的药物选择，以及为这些复杂患者采用并参与多学科护理模式。
