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围手术期老年服务中的谵妄管理:非药物策略的叙述性综述

Delirium management in perioperative geriatric services: a narrative review of non-pharmaceutical strategies.

作者信息

Travers Rozenn, Gagliardi Geoffroy, Ramseyer Maximilian

机构信息

Service de Court Séjour Gériatrique, Pôle Médecines Fortes Consultations, Centre Hospitalier Universitaire d'Orléans, Orléans, France.

Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States.

出版信息

Front Psychiatry. 2024 Jun 17;15:1394583. doi: 10.3389/fpsyt.2024.1394583. eCollection 2024.

Abstract

Delirium, a common complication in elderly surgical patients, poses significant challenges in perioperative care. Perioperative geriatric services (PGS) aim at managing comorbidities, postoperative complications, and initiating early recovery of mobility to enhance elderly patients' prognosis in the perioperative period. Studies have shown that patients with preoperative cognitive disorders are at a significantly increased risk of postoperative delirium. While postoperative delirium affects up to 70% of people over 60 and 90% of people with neurodegenerative diseases, it remains underdiagnosed in many cases. Postoperative delirium can lead to functional decline, prolonged hospitalization, increased healthcare costs, cognitive impairment, and psychological malaise. This article briefly summarizes the literature on delirium, its risk factors, and its non-pharmaceutical management strategies within the perioperative period. It highlights the importance of integrating cognitive and psychological assessments into perioperative care protocols to provide baseline data, improve patient outcomes, reduce hospital stays, and minimize complications associated with delirium. By embracing evidence-based delirium management protocols, healthcare professionals can better identify and manage delirium, ultimately improving the quality of care for elderly surgical patients, which would also benefit healthcare staff and healthcare institutions.

摘要

谵妄是老年外科患者常见的并发症,给围手术期护理带来重大挑战。围手术期老年服务(PGS)旨在管理合并症、术后并发症,并促进早期活动恢复,以改善老年患者围手术期的预后。研究表明,术前有认知障碍的患者术后发生谵妄的风险显著增加。虽然术后谵妄影响高达70%的60岁以上人群和90%的神经退行性疾病患者,但在许多情况下仍未得到充分诊断。术后谵妄可导致功能衰退、住院时间延长、医疗费用增加、认知障碍和心理不适。本文简要总结了围手术期谵妄及其危险因素和非药物管理策略的文献。它强调了将认知和心理评估纳入围手术期护理方案的重要性,以提供基线数据、改善患者预后、缩短住院时间,并将与谵妄相关的并发症降至最低。通过采用基于证据的谵妄管理方案,医护人员可以更好地识别和管理谵妄,最终提高老年外科患者的护理质量,这也将使医护人员和医疗机构受益。

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