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[老年泌尿外科患者的谵妄]

[Delirium in geriatric urology patients].

作者信息

Becher K F

机构信息

Abteilung für Geriatrie und Frührehabilitation, Helios Hanseklinikum Stralsund GmbH, Große Parower Straße 47-53, 18435, Stralsund, Deutschland.

出版信息

Urologe A. 2019 Apr;58(4):398-402. doi: 10.1007/s00120-019-0887-4.

Abstract

BACKGROUND

Delirium is a common but often undiagnosed complication in geriatric patients following a major or minor operation. With 14-56% in patients over 70 years of age, it is one of the most frequent complications seen in hospitals. The link between the prescription of drugs with antimuscarinic effects and cognitive disturbance is also well known.

METHODS

Recognizing the presence of delirium and the criteria to establish the diagnosis of delirium will improve a clinician's ability to detect this complication. Treating delirium with non-pharmacologic, reduces the incidence and side effects of postoperative delirium. The purpose of this article is to describe the diagnosis and treatment of postoperative delirium.

RESULTS

A sudden rise following fluctuating symptoms with decreased attentiveness, awareness and thinking are typical symptoms of delirium. The organic origin is not focused and must be considered. Transurethral resection (TUR) of the prostate and the bladder can increase the risk of bleeding, delirium and TUR syndrome. As simple instruments to assess signs and symptoms, the Clinical Assessment Method (CAM) and the Nurses Delirium Screening Scale (Nu-DESC) in the clinical setting are well examined.

CONCLUSIONS

Preoperatively screening and execution of a geriatric assessment to detect vulnerable elderly could be a first step in reduction of complication. Regularly screening for delirium reduces the pre-, post-, and perioperative complications in patients with delirium.

摘要

背景

谵妄是老年患者在接受大手术或小手术后常见但常未被诊断出的并发症。在70岁以上的患者中发生率为14% - 56%,它是医院中最常见的并发症之一。具有抗胆碱能作用的药物处方与认知障碍之间的联系也广为人知。

方法

认识到谵妄的存在以及确立谵妄诊断的标准将提高临床医生检测这种并发症的能力。采用非药物方法治疗谵妄可降低术后谵妄的发生率和副作用。本文的目的是描述术后谵妄的诊断和治疗。

结果

注意力、意识和思维下降且症状波动后突然加重是谵妄的典型症状。其器质性病因不明确,必须加以考虑。经尿道前列腺切除术(TUR)和膀胱切除术会增加出血、谵妄和TUR综合征的风险。作为评估体征和症状的简单工具,临床评估方法(CAM)和护士谵妄筛查量表(Nu - DESC)在临床环境中已得到充分检验。

结论

术前进行筛查并实施老年评估以发现脆弱的老年人可能是减少并发症的第一步。定期筛查谵妄可减少谵妄患者术前、术后及围手术期的并发症。

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