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谵妄护理中的创新:一种使用触摸和活动来扭转注意力不集中的标准化干预措施。

Innovation in delirium care: A standardized intervention to reverse inattention using touch and movement.

作者信息

Bisson Dana E, Clancy Burgess Shannon C, Gamache Michelle E, Dunn Maureen P, Valeras Aimee B, Lindpaintner Lyn S

机构信息

Concord Hospital, Concord, New Hampshire, USA.

出版信息

J Am Geriatr Soc. 2025 Apr;73(4):1008-1016. doi: 10.1111/jgs.19254. Epub 2024 Nov 29.

DOI:10.1111/jgs.19254
PMID:39611548
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11970217/
Abstract

Delirium is a complex neurocognitive disorder characterized by an acute disturbance in attention, awareness, and perception. It is a dangerous syndrome that is independently associated with higher rates of morbidity and mortality, inpatient complications, and is a predictor of long-term cognitive dysfunction. Although delirium can occur in persons of all ages, the prevalence among and impact on older adults is particularly significant. Current gold standard approaches for delirium include treating medical precipitants and physiological perturbations and optimizing the environment using multicomponent nonpharmacological interventions. Although these approaches are proven effective in preventing delirium, evidence has not shown them to significantly improve delirium once it occurs. The need for a safe, effective, and specific treatment for the phenotype of delirium itself is an urgent priority worldwide. The intervention described in this article, Attention and Awareness Through Movement technique followed by Movement To Capacity (AATM/MTC), targets cortical dysfunction through sustained sequential touch, cranial nerve stimulation, and muscular movement. It raises the tantalizing possibility that a specific method to reduce inattention and normalize arousal levels may not only be feasible but also safe and inexpensive. For these reasons, preliminary observations are described in the hope of stimulating interest in further exploration of this novel approach to delirium therapy.

摘要

谵妄是一种复杂的神经认知障碍,其特征为注意力、意识和感知的急性紊乱。它是一种危险的综合征,与较高的发病率、死亡率、住院并发症独立相关,并且是长期认知功能障碍的一个预测指标。虽然谵妄可发生于所有年龄段的人群,但在老年人中的患病率及其影响尤为显著。目前针对谵妄的金标准方法包括治疗医学诱因和生理紊乱,以及使用多组分非药物干预措施优化环境。尽管这些方法已被证明在预防谵妄方面有效,但证据表明,一旦谵妄发生,它们并不能显著改善谵妄症状。全球迫切需要一种针对谵妄本身表型的安全、有效且特异性的治疗方法。本文所述的干预措施,即通过运动实现注意力和意识训练技术,随后进行能力运动训练(AATM/MTC),通过持续的顺序触摸、颅神经刺激和肌肉运动来针对皮质功能障碍。这引发了一种诱人的可能性,即一种减少注意力不集中和使觉醒水平正常化的特定方法不仅可行,而且安全且廉价。基于这些原因,本文描述了初步观察结果,以期激发人们对进一步探索这种治疗谵妄的新方法的兴趣。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae93/11970217/d2efd55d8413/JGS-73-1008-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae93/11970217/b6357fec50b0/JGS-73-1008-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae93/11970217/22554b9834eb/JGS-73-1008-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae93/11970217/abe7a975f4d7/JGS-73-1008-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae93/11970217/d2efd55d8413/JGS-73-1008-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae93/11970217/b6357fec50b0/JGS-73-1008-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae93/11970217/22554b9834eb/JGS-73-1008-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae93/11970217/abe7a975f4d7/JGS-73-1008-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae93/11970217/d2efd55d8413/JGS-73-1008-g003.jpg

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本文引用的文献

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Preventing and treating delirium in clinical settings for older adults.在临床环境中预防和治疗老年人的谵妄
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Delirium in the intensive care unit and its importance in the post-operative context: A review.重症监护病房中的谵妄及其在术后背景下的重要性:综述
Front Med (Lausanne). 2023 Mar 30;10:1071854. doi: 10.3389/fmed.2023.1071854. eCollection 2023.
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Non-Pharmacological Nursing Interventions to Prevent Delirium in ICU Patients-An Umbrella Review with Implications for Evidence-Based Practice.
预防ICU患者谵妄的非药物护理干预措施——一项对循证实践有启示的系统性综述
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Brain Network Dysfunction in Poststroke Delirium and Spatial Neglect: An fMRI Study.脑卒后谵妄和空间忽视的脑网络功能障碍:一项 fMRI 研究。
Stroke. 2022 Mar;53(3):930-938. doi: 10.1161/STROKEAHA.121.035733. Epub 2021 Oct 8.
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Delirium and Associated Length of Stay and Costs in Critically Ill Patients.危重症患者的谵妄及其相关住院时长和费用
Crit Care Res Pract. 2021 Apr 24;2021:6612187. doi: 10.1155/2021/6612187. eCollection 2021.
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A Study of the Psychometric Properties of the "Stanford Proxy Test for Delirium" (S-PTD): A New Screening Tool for the Detection of Delirium.斯坦福代理谵妄测试(S-PTD)的心理测量学特性研究:一种用于检测谵妄的新筛查工具。
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Association between Inpatient Delirium and Hospital Readmission in Patients ≥ 65 Years of Age: A Retrospective Cohort Study.65岁及以上患者住院期间谵妄与再次入院的关联:一项回顾性队列研究
J Hosp Med. 2019 Apr;14(4):201-206. doi: 10.12788/jhm.3130.
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Hospital Elder Life Program: Systematic Review and Meta-analysis of Effectiveness.医院老年人生活计划:有效性的系统评价和荟萃分析。
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