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脓毒症相关性谵妄:一篇叙述性综述

Sepsis-Associated Delirium: A Narrative Review.

作者信息

Tokuda Rina, Nakamura Kensuke, Takatani Yudai, Tanaka Chie, Kondo Yutaka, Ohbe Hiroyuki, Kamijo Hiroshi, Otake Kosuke, Nakamura Atsuo, Ishikura Hiroyasu, Kawazoe Yu

机构信息

Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, Hyogo 668-8501, Japan.

Department of Emergency and Critical Care Medicine, Teikyo University Hospital, Tokyo 173-8606, Japan.

出版信息

J Clin Med. 2023 Feb 6;12(4):1273. doi: 10.3390/jcm12041273.

Abstract

Delirium is characterized by an acutely altered mental status accompanied by reductions in cognitive function and attention. Delirium in septic patients, termed sepsis-associated delirium (SAD), differs in several specific aspects from the other types of delirium that are typically encountered in intensive care units. Since sepsis and delirium are both closely associated with increased morbidity and mortality, it is important to not only prevent but also promptly diagnose and treat SAD. We herein reviewed the etiology, pathogenesis, risk factors, prevention, diagnosis, treatment, and prognosis of SAD, including coronavirus disease 2019 (COVID-19)-related delirium. Delirium by itself not only worsens long-term prognosis, but it is also regarded as an important factor affecting the outcome of post-intensive care syndrome. In COVID-19 patients, the difficulties associated with adequately implementing the ABCDEF bundle (Assess, prevent, and manage pain; Both spontaneous awakening and breathing trials: Choice of analgesia and sedation; Delirium assess, prevent, and manage; Early mobility and exercise; Family engagement/empowerment) and the need for social isolation are issues that require the development of conventional care for SAD.

摘要

谵妄的特征是精神状态急性改变,同时伴有认知功能和注意力下降。脓毒症患者的谵妄,称为脓毒症相关性谵妄(SAD),在几个特定方面与重症监护病房中常见的其他类型谵妄有所不同。由于脓毒症和谵妄都与发病率和死亡率增加密切相关,因此不仅要预防,而且要及时诊断和治疗SAD,这一点很重要。我们在此回顾了SAD的病因、发病机制、危险因素、预防、诊断、治疗和预后,包括与2019冠状病毒病(COVID-19)相关的谵妄。谵妄本身不仅会恶化长期预后,而且还被视为影响重症监护后综合征结局的一个重要因素。在COVID-19患者中,充分实施ABCDEF集束化治疗(评估、预防和管理疼痛;自主觉醒和呼吸试验:镇痛和镇静的选择;谵妄评估、预防和管理;早期活动和锻炼;家属参与/赋权)存在困难,以及需要进行社交隔离,这些都是需要为SAD制定常规护理措施的问题。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c280/9962483/2e5ef4981310/jcm-12-01273-g001.jpg

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