Braune Stephan, Gurlit Simone
Dtsch Med Wochenschr. 2019 Nov;144(23):1611-1618. doi: 10.1055/a-0666-3947. Epub 2019 Nov 21.
A delirium in patients in the intensive care unit (ICU) is a manifestation of a severe acute dysfunction of the brain. It has a high prevalence and is associated with a relevant increase in morbidity and mortality. A cholinergic deficit and dopaminergic overactivity are considered to be a cause of delirium. Polypharmacy, which is often present before admission to the ICU, especially in the elderly, plays a key role as a trigger. The knowledge and identification of risk factors for delirium is a precondition for the early and effective prevention of delirium. The aim is the pre-operative or pre-interventional optimization of modifiable risk factors. Early and effective prevention of delirium can improve clinical outcome, reduce mortality, and positively impact long-term functional outcome. Non-pharmacological measures are always the basis for the prevention of delirium: maintenance of the day-night rhythm, sleep promotion at night and stimulation during the day, involvement of relatives, the avoidance of dehydration and malnutrition, and others more. They are pharmacologically accompanied by an effective analgesia and a target and symptom-oriented sedation with well controllable, as little as possible delirogenic substances. Interdisciplinary and interprofessional cooperation is essential so that preventive concepts significantly reduce the risk of delirium, even in high-risk patients.
重症监护病房（ICU）患者的谵妄是严重急性脑功能障碍的一种表现。其患病率很高，且与发病率和死亡率的显著增加相关。胆碱能缺乏和多巴胺能活动过度被认为是谵妄的一个原因。多重用药，常在入住ICU之前就已存在，尤其是在老年人中，作为一个触发因素起着关键作用。了解和识别谵妄的危险因素是早期有效预防谵妄的前提条件。目标是在术前或介入前优化可改变的危险因素。早期有效预防谵妄可改善临床结局、降低死亡率，并对长期功能结局产生积极影响。非药物措施始终是预防谵妄的基础：维持昼夜节律、促进夜间睡眠和白天刺激、亲属参与、避免脱水和营养不良等等。在药物方面，辅以有效的镇痛以及使用可控性良好、尽可能少引起谵妄的药物进行目标导向和症状导向的镇静。跨学科和跨专业合作至关重要，这样预防方案才能显著降低谵妄风险，即使对高危患者也是如此。
