急诊科老年患者谵妄的预防与管理
Delirium Prevention and Management in Older Adults in the Emergency Department.
作者信息
Skains Rachel M, Lee Sangil, Han Jin H
机构信息
Department of Emergency Medicine, University of Alabama at Birmingham School of Medicine, 521 19th Street South, Suite 203, Birmingham, AL 35233, USA; Geriatric Research, Education, and Clinical Center, Birmingham Veterans Affairs Medical Center, 700 19th Street South, Birmingham, AL 35233, USA.
Department of Emergency Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 1008 Roy Carver Pavilion, Iowa City, IA 52242, USA. Electronic address: https://twitter.com/kagochi28.
出版信息
Emerg Med Clin North Am. 2025 May;43(2):249-263. doi: 10.1016/j.emc.2024.08.007. Epub 2025 Feb 14.
Delirium, acute brain dysfunction, is present in 10% to 35% of older adults in the emergency department (ED) but unrecognized in ∼80% of cases leading to significant adverse outcomes. Thus, routine screening for delirium is vital to improve prevention and management in the ED. The treatment of delirium focuses on addressing the underlying cause. For agitation, nonpharmacologic measures using the Tolerate, Anticipate, and Don't Agitate (TADA) approach and the Assess, Diagnose, Evaluate, Prevent, and Treat (ADEPT) tool are prioritized for management. If unsuccessful, only the lowest effective dose of pharmacologic agents (atypical antipsychotics) should be used for severe symptom control.
谵妄，即急性脑功能障碍，在急诊科（ED）10%至35%的老年人中存在，但约80%的病例未被识别，从而导致严重不良后果。因此，常规筛查谵妄对于改善急诊科的预防和管理至关重要。谵妄的治疗重点是解决潜在病因。对于躁动，优先采用容忍、预期和不激惹（TADA）方法以及评估、诊断、评估、预防和治疗（ADEPT）工具等非药物措施进行管理。如果不成功，仅应使用最低有效剂量的药物（非典型抗精神病药物）来控制严重症状。
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