von Haken R, Gruss M, Plaschke K, Scholz M, Engelhardt R, Brobeil A, Martin E, Weigand M A
Klinik für Anaesthesiologie, Ruprecht-Karls-Universität Heidelberg, Deutschland.
Anaesthesist. 2010 Mar;59(3):235-47. doi: 10.1007/s00101-009-1664-3.
In recent years delirium in the intensive care unit (ICU) has internationally become a matter of rising concern for intensive care physicians. Due to the design of highly sophisticated ventilators the practice of deep sedation is nowadays mostly obsolete. To assess a ventilated ICU patient for delirium easy to handle bedside tests have been developed which permit a psychiatric scoring. The significance of ICU delirium is equivalent to organ failure and has been proven to be an independent prognostic factor for mortality and length of ICU and hospital stay. The pathophysiology and risk factors of ICU delirium are still insufficiently understood in detail. A certain constellation of pre-existing patient-related conditions, the current diagnosis and surgical procedure and administered medication entail a higher risk for the occurrence of ICU delirium. A favored hypothesis is that an imbalance of the neurotransmitters acetylcholine and dopamine serotonin results in an unpredictable neurotransmission. Currently, the administration of neuroleptics, enforced physiotherapy, re-orientation measures and appropriate pain treatment are the basis of the therapeutic approach.
近年来，重症监护病房（ICU）中的谵妄在国际上已日益成为重症监护医生关注的问题。由于高度精密呼吸机的设计，如今深度镇静的做法大多已过时。为了评估接受机械通气的ICU患者是否存在谵妄，已开发出易于操作的床边测试，这些测试可进行精神科评分。ICU谵妄的重要性等同于器官衰竭，并且已被证明是死亡率以及ICU和住院时间的独立预后因素。ICU谵妄的病理生理学和危险因素仍未得到充分详细的了解。某些预先存在的与患者相关的情况、当前的诊断和外科手术以及所用药物会使发生ICU谵妄的风险更高。一种流行的假说是，神经递质乙酰胆碱、多巴胺和5-羟色胺失衡会导致不可预测的神经传递。目前，使用抗精神病药物、加强物理治疗、重新定向措施和适当的疼痛治疗是治疗方法的基础。
