重症监护病房谵妄：诊断、预防及治疗综述
Intensive Care Unit Delirium: A Review of Diagnosis, Prevention, and Treatment.
作者信息
Hayhurst Christina J, Pandharipande Pratik P, Hughes Christopher G
机构信息
From the Division of Anesthesiology Critical Care Medicine, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee.
出版信息
Anesthesiology. 2016 Dec;125(6):1229-1241. doi: 10.1097/ALN.0000000000001378.
Abstract
A 77 year-old male is admitted to the hospital after sustaining a hip fracture. He has a past medical history of chronic obstructive pulmonary disease, hypertension, hyperlipidemia, chronic back pain, and hearing loss. Prior to surgery he receives midazolam for agitation and morphine for pain control. He undergoes a general anesthetic for his fracture repair, requiring high doses of fentanyl for pain control. Postoperatively, he has poor pulmonary mechanics and is taken to the ICU intubated and mechanically ventilated. On postoperative day one, his sedation is weaned and he is put on a spontaneous breathing trial. While he appears intermittently awake, he will not follow commands and only intermittently makes eye contact. The patient is left intubated due to his altered mental status.
摘要
一名77岁男性在髋部骨折后入院。他既往有慢性阻塞性肺疾病、高血压、高脂血症、慢性背痛和听力丧失病史。手术前，他因烦躁接受咪达唑仑治疗，因疼痛控制接受吗啡治疗。他接受全身麻醉进行骨折修复，需要高剂量芬太尼来控制疼痛。术后，他的肺功能不佳，被送入重症监护病房，进行气管插管和机械通气。术后第一天，他的镇静药物逐渐减量，并进行自主呼吸试验。虽然他有时看起来清醒，但他不服从指令，只是偶尔进行眼神交流。由于精神状态改变，患者仍保留气管插管。
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