老年人急性意识混乱状态——诊断与治疗。
Acute confusional States in the elderly--diagnosis and treatment.
机构信息
Clinic and Policlinic for Neurology, Großhadern clinic, Ludwig Maximilian University of Munich, Germany.
出版信息
Dtsch Arztebl Int. 2012 May;109(21):391-9; quiz 400. doi: 10.3238/arztebl.2012.0391. Epub 2012 May 25.
BACKGROUND
Delirium is common, has multiple causes and causes distress to numerous patients and their relatives.
METHOD
Selective review of the literature in PubMed and PsycINFO, with reference to selected national and international guidelines.
RESULTS
The hypoactive subtype of delirium is commoner than the hyperactive type, and often overlooked. Delirium in an elderly individual is associated with an additional burden, a possible loss of potential for rehabilitation, and a marked increase in mortality. The diagnosis of delirium is primarily clinical. All professionals involved in patient care must be able to recognize the features of delirium. Dementia, dehydration and polypharmacy are particularly strongly associated, in the elderly. A careful history and examination with appropriate investigation allows underlying causes to be detected and treated. Rehabilitation strategies should be initiated without delay. Neuroleptics and benzodiazepines have an established role in the pharmacological treatment even of the hyperactive subtype. Non-pharmacological treatments include the creation of a calm and patient centred environment, and the involvement of relatives.
CONCLUSION
In many cases, delirium can be diagnosed and treated in good time. Prevention is preferable to treatment.
背景
谵妄很常见，有多种病因，会给许多患者及其家属带来痛苦。
方法
在 PubMed 和 PsycINFO 中选择性地查阅文献，并参考了一些国家和国际指南。
结果
谵妄的活动减退型比活动亢进型更为常见，但往往被忽视。老年人的谵妄与额外的负担、康复潜力的丧失以及死亡率的显著增加有关。谵妄的诊断主要是临床诊断。所有参与患者护理的专业人员都必须能够识别出谵妄的特征。痴呆、脱水和多种药物治疗在老年人中与谵妄的关联尤为密切。仔细的病史和体格检查，并进行适当的检查，可以发现并治疗潜在的病因。应立即启动康复策略。神经阻滞剂和苯二氮䓬类药物在治疗包括活动亢进型在内的谵妄亚型方面已有明确的作用。非药物治疗包括营造一个安静和以患者为中心的环境，并让家属参与。
结论
在许多情况下，谵妄可以及时诊断和治疗。预防优于治疗。
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