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[老年和高龄患者的药物性谵妄]

[Drug-induced delirium in elderly and senile patients].

作者信息

Pereverzev A P, Ostroumova O D, Isaev R I, Tkacheva O N, Kotovskaya Yu V

机构信息

Pirogov Russian National Research Medical University, Russian Clinical and Research Center of Gerontology, Moscow, Russia.

出版信息

Zh Nevrol Psikhiatr Im S S Korsakova. 2019;119(7):120-127. doi: 10.17116/jnevro2019119071120.

Abstract

Drug-induced delirium is an urgent challenge of modern healthcare, especially in elderly patients, due to the widespread prevalence, associated complications, longer hospitalization period, higher mortality rate. The exact pathogenesis of delirium is unknown, however, a number of studies suggest that it is based on neurotransmitter dysfunction. Thus, drugs that affect the metabolism of these neurotransmitters can lead to the onset of delirium. The Delirium Drug Scale (DDS) and the Anticholinergic Burden scale (ACB) are used to assess the risk of delirium. For patients with an increased risk of delirium, it is recommended to avoid prescribing benzodiazepines, use with caution opiates, dihydropyridines and antagonists of H1-histamine receptors. Non-pharmacological methods are recommended as a first-line treatment of delirium (behavioral approaches, placing the patient in specially equipped delirious rooms, etc.). If non-pharmacological methods have shown to be ineffective or the patient's behavior represents a danger to the life and health of himself and / or others, it is possible to administer antipsychotic drugs.

摘要

药物性谵妄是现代医疗保健面临的一项紧迫挑战,尤其是在老年患者中,这是由于其广泛的患病率、相关并发症、更长的住院时间和更高的死亡率。谵妄的确切发病机制尚不清楚,然而,一些研究表明它基于神经递质功能障碍。因此,影响这些神经递质代谢的药物可导致谵妄的发作。谵妄药物量表(DDS)和抗胆碱能负担量表(ACB)用于评估谵妄风险。对于谵妄风险增加的患者,建议避免开具苯二氮䓬类药物,谨慎使用阿片类药物、二氢吡啶类药物和H1组胺受体拮抗剂。非药物方法被推荐作为谵妄的一线治疗方法(行为方法、将患者安置在配备特殊设施的谵妄病房等)。如果非药物方法已证明无效或患者的行为对其自身和/或他人的生命和健康构成危险,则可使用抗精神病药物。

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