Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts 02215, USA.
JAMA. 2012 Jul 4;308(1):73-81. doi: 10.1001/jama.2012.6857.
Delirium (acute confusion) complicates 15% to 50% of major operations in older adults and is associated with other major postoperative complications, prolonged length of stay, poor functional recovery, institutionalization, dementia, and death. Importantly, delirium may be predictable and preventable through proactive intervention. Yet clinicians fail to recognize and address postoperative delirium in up to 80% of cases. Using the case of Ms R, a 76-year-old woman who developed delirium first after colectomy with complications and again after routine surgery, the diagnosis, prevention, and treatment of delirium in the postoperative setting is reviewed. The risk of postoperative delirium can be quantified by the sum of predisposing and precipitating factors. Successful strategies for prevention and treatment of delirium include proactive multifactorial intervention targeted to reversible risk factors, limiting use of sedating medications (especially benzodiazepines), effective management of postoperative pain, and, perhaps, judicious use of antipsychotics.
谵妄（急性意识混乱）在老年患者中 15%至 50%的重大手术中发生，并且与其他重大术后并发症、住院时间延长、功能恢复不良、住院治疗、痴呆和死亡有关。重要的是，谵妄可以通过积极干预来预测和预防。然而，高达 80%的病例中，临床医生未能识别和处理术后谵妄。通过 76 岁女性患者 R 女士的病例，她在接受结肠切除术和并发症后首先出现谵妄，然后在常规手术后再次出现谵妄，对术后发生谵妄的诊断、预防和治疗进行了回顾。通过潜在和诱发因素的总和，可以对术后谵妄的风险进行量化。预防和治疗谵妄的成功策略包括针对可逆转风险因素的积极多因素干预、限制使用镇静药物（尤其是苯二氮䓬类药物）、有效管理术后疼痛，以及合理使用抗精神病药物。
