Restrepo Bernal Diana, Niño García Jorge Andrés, Ortiz Estévez Daniel Eduardo
Universidad CES, Colombia.
Universidad Industrial de Santander, Colombia.
Rev Colomb Psiquiatr. 2016 Jan-Mar;45(1):37-45. doi: 10.1016/j.rcp.2015.06.005. Epub 2015 Sep 19.
Delirium is the most prevalent neuropsychiatric syndrome in the general hospital. Its presence is a marker of poor prognosis for patients. Its prevention could be the most effective strategy for reducing its frequency and its complications.
To review recent findings and strategies for the prevention of delirium.
A non-systematic review of scientific articles published in the last ten years in Spanish and English. A search was made in databases such as MEDLINE, Cochrane, EMBASE, Ovid, and ScienceDirect, for articles that included the terms, delirium and prevention.
Identification of predisposing and precipitating factors for delirium and a better understanding of the pathophysiological mechanisms underlying the onset of delirium have enabled the implementation of various pharmacological and non-pharmacological strategies in patients at high risk to develop hospital delirium. The studies to prevent delirium have focused on surgical patients. The current evidence supports the daily implementation of non-pharmacological measures to prevent delirium, as they are easy and cost effective. The available evidence is still limited to recommend the daily use of pharmacological strategies in delirium prophylaxis, and there is a consensus against the modest use of antipsychotic drugs in surgical patients and dexmedetomidine in patients in intensive care.
New high-quality clinical trials and studies involving non-surgical patients are needed to provide more evidence about this subject.
谵妄是综合医院中最常见的神经精神综合征。它的出现是患者预后不良的一个标志。预防谵妄可能是降低其发生率及其并发症的最有效策略。
综述预防谵妄的最新研究结果和策略。
对过去十年以西班牙语和英语发表的科学文章进行非系统综述。在MEDLINE、Cochrane、EMBASE、Ovid和ScienceDirect等数据库中进行检索，查找包含“谵妄”和“预防”等术语的文章。
识别谵妄的易感因素和促发因素，并更好地理解谵妄发生的病理生理机制，使得能够对有发生医院谵妄高风险的患者实施各种药物和非药物策略。预防谵妄的研究主要集中在外科患者。目前的证据支持每日实施非药物措施来预防谵妄，因为这些措施简便且具有成本效益。现有证据仍有限，不足以推荐每日使用药物策略预防谵妄，并且对于在外科患者中适度使用抗精神病药物以及在重症监护患者中使用右美托咪定存在共识反对意见。
需要开展新的高质量临床试验以及涉及非外科患者的研究，以提供关于该主题的更多证据。
