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重症监护病房中的谵妄

Delirium in the Intensive Care Unit.

作者信息

Arumugam Suresh, El-Menyar Ayman, Al-Hassani Ammar, Strandvik Gustav, Asim Mohammad, Mekkodithal Ahammed, Mudali Insolvisagan, Al-Thani Hassan

机构信息

Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar.

Department of Surgery, Trauma Surgery Section, Hamad Medical Corporation, Doha, Qatar; Deaprtment of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.

出版信息

J Emerg Trauma Shock. 2017 Jan-Mar;10(1):37-46. doi: 10.4103/0974-2700.199520.

Abstract

Delirium is characterized by impaired cognition with nonspecific manifestations. In critically ill patients, it may develop secondary to multiple precipitating or predisposing causes. Although it can be a transient and reversible syndrome, its occurrence in Intensive Care Unit (ICU) patients may be associated with long-term cognitive dysfunction. This condition is often under-recognized by treating physicians, leading to inappropriate management. For appropriate management of delirium, early identification and risk factor assessment are key factors. Multidisciplinary collaboration and standardized care can enhance the recognition of delirium. Interdisciplinary team working, together with updated guideline implementation, demonstrates proven success in minimizing delirium in the ICU. Moreover, should the use of physical restraint be necessary to prevent harm among mechanically ventilated patients, ethical clinical practice methodology must be employed. This traditional narrative review aims to address the presentation, risk factors, management, and ethical considerations in the management of delirium in ICU settings.

摘要

谵妄的特征是认知功能受损且表现不具特异性。在危重症患者中,它可能继发于多种促发或诱发因素。尽管它可能是一种短暂且可逆的综合征,但在重症监护病房(ICU)患者中发生时,可能与长期认知功能障碍有关。这种情况往往未得到治疗医师的充分认识,导致管理不当。对于谵妄的恰当管理,早期识别和危险因素评估是关键因素。多学科协作和标准化护理可提高对谵妄的识别。跨学科团队合作以及实施更新的指南,已证明在减少ICU中的谵妄方面取得了成功。此外,如果有必要对机械通气患者使用身体约束以防止伤害,必须采用符合伦理的临床实践方法。这篇传统的叙述性综述旨在探讨ICU环境中谵妄的表现、危险因素、管理及伦理考量。

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