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[谵妄:长期后遗症及后续护理,特别考虑创伤后应激障碍]

[Delirium: long-term sequelae and aftercare with special consideration to posttraumatic stress disorder].

作者信息

Hertrich Anna Carola, Grundei Sophia

机构信息

Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Zentrum für Anästhesiologie und Intensivmedizin, Martinistraße 52, 20246, Hamburg, Deutschland.

Abteilung für Innere Medizin I, Medizinische Universität Innsbruck, Gemeinsame Einrichtung für Internistische Intensiv- und Notfallmedizin, Anichstraße 35, 6020, Innsbruck, Österreich.

出版信息

Med Klin Intensivmed Notfmed. 2025 Jun;120(5):397-402. doi: 10.1007/s00063-025-01279-4. Epub 2025 May 5.

Abstract

Delirium is a frequent syndrome among hospitalized patients, with a prevalence of 10-30% on general wards, up to 50% on palliative care units and 30-80% on intensive care units (ICU). Defined in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) as an acute, reversible disturbance of attention, cognition and consciousness, delirium is associated with infections, surgery, trauma and other disease conditions. Risk factors include advanced age, pre-existing neurocognitive disorders and substance abuse. Delirium is associated with increased mortality, longer hospitalization and the occurrence of post-hospital discharge complications, including post-intensive care syndrome (PICS) and posttraumatic stress disorder (PTSD). A structured post-inpatient management is limited, highlighting the need for specialized aftercare clinics. On the ICU early detection through tools, such as confusion assessment method for the ICU (CAM-ICU) and preventive measures, including the ABCDEF bundle, are essential. Family involvement and patient education can mitigate long-term effects. A greater awareness of the impact of delirium and the long-term sequelae is crucial to improve patient recovery and to address both physical and psychological needs.

摘要

谵妄是住院患者中常见的综合征,在普通病房的患病率为10%至30%,在姑息治疗病房高达50%,在重症监护病房(ICU)为30%至80%。在《精神疾病诊断与统计手册》第五版(DSM-V)中,谵妄被定义为注意力、认知和意识的急性、可逆性障碍,与感染、手术、创伤和其他疾病状况相关。危险因素包括高龄、既往神经认知障碍和药物滥用。谵妄与死亡率增加、住院时间延长以及出院后并发症的发生有关,包括重症监护后综合征(PICS)和创伤后应激障碍(PTSD)。住院后的结构化管理有限,这凸显了设立专门的后续护理诊所的必要性。在ICU,通过诸如ICU意识模糊评估法(CAM-ICU)等工具进行早期检测以及采取包括ABCDEF集束化治疗在内的预防措施至关重要。家属参与和患者教育可以减轻长期影响。提高对谵妄影响及其长期后遗症的认识对于改善患者康复以及满足身体和心理需求至关重要。

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