Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System GRECC, 150 South Huntington Ave., Boston, MA 02130, USA.
Anesth Analg. 2011 May;112(5):1202-11. doi: 10.1213/ANE.0b013e3182147f6d. Epub 2011 Apr 7.
Delirium is an acute change in cognition and attention, which may include alterations in consciousness and disorganized thinking. Although delirium may affect any age group, it is most common in older patients, especially those with preexisting cognitive impairment. Patients with delirium after surgery recover more slowly than those without delirium and, as a result, have increased length of stay and hospital costs. The measured incidence of postoperative delirium varies with the type of surgery, the urgency of surgery, and the type and sensitivity of the delirium assessment. Although generally considered a short-term condition, delirium can persist for months and is associated with poor cognitive and functional outcomes beyond the immediate postoperative period. In this article, we provide a guide to assess delirium risk preoperatively and to prevent, diagnose, and treat this common and morbid condition. Care improvements such as identifying delirium risk preoperatively; training surgeons, anesthesiologists, and nurses to screen for delirium; implementing delirium prevention programs; and developing standardized delirium treatment protocols may reduce the risk of delirium and its associated morbidity.
谵妄是一种急性认知和注意力改变，可能包括意识改变和思维紊乱。尽管谵妄可能发生在任何年龄组，但在老年患者中更为常见，尤其是那些有预先存在的认知障碍的患者。手术后出现谵妄的患者恢复速度比没有出现谵妄的患者慢，因此住院时间和住院费用增加。术后谵妄的发生率因手术类型、手术紧迫性以及谵妄评估的类型和敏感性而异。尽管一般认为是短期情况，但谵妄可能持续数月，并与术后即刻以外的认知和功能结果不良相关。在本文中，我们提供了术前评估谵妄风险以及预防、诊断和治疗这种常见且病态的疾病的指南。通过术前识别谵妄风险、培训外科医生、麻醉师和护士进行谵妄筛查、实施谵妄预防计划以及制定标准化的谵妄治疗方案等护理改进措施，可能降低谵妄及其相关发病率的风险。
