<strong>术后谵妄的研究进展</strong>

摘要/Abstract

摘要：谵妄是一种以急性意识和认知功能障碍为特征的脑综合症。手术后患者出现谵妄不仅会增加术后并发症及医疗费用、延长住院时间，还会增加远、近期死亡率，且一旦发生谵妄，其术后长期认知功能也显著下降。对术后谵妄的诊断、预防和治疗是外科围术期的重要内容。近年来，在手术后谵妄发生、发展及诊治方面有较多的研究且也取得了一定的进展。本文就对术后谵妄发生的病理生理学机制、危险因素、诊断、预防以及治疗等方面的研究进展进行综述。

关键词:术后,谵妄,诊断,治疗,预防

Abstract:Delirium is an acute cerebral syndrome characterized by disturbances of consciousness and cognitive function. Delirium after operations is associated with increased postoperative complications, high hospitalization cost, long hospitalization, and it can increase short-term and long-term mortality, reduce cognitive functioning. The diagnosis, treatment and prevention of delirium are of great importance for perioperative patients undergoing surgery. In recent years, there has been many investigations made for the occurrence, development, diagnosis and treatment of delirium after surgery, and some progress has been made. This review focuses on the pathophysiology, risk factors, diagnostic methods, treatment and preventive strategies of delirium after surgery.

Key words:Postoperative,Delirium,Diagnosis,Treatment,Prevention

中图分类号:

R964

薛占霞, 高永山 .术后谵妄的研究进展[J]. 神经药理学报, 2014, 4(4): 20-27.

XUE Zhan-xia，GAO Yong-shan.Research Progress of Postoperative Delirium[J]. Acta Neuropharmacologica, 2014, 4(4): 20-27.

参考文献

参考文献

[1] 任燕，张丽莉，曾玲. 心脏外科手术后谵妄的研究进展[J].中国胸心血管外科临床杂志, 2014, 21(6):822-826.

[2] Kotaro Hatta, Yasuhiro Kishi, Ken Wada. et al. Preventive effects of ramelteon on delirium:a randomized placebo-controlled trial[J].JAMA Psychiatry, 2014, 71(4):397-403.

[3] Robert D Sanders, PP Pandharipande, AJ Davidson, et al. Anticipating and managing postoperative delirium and cognitive decline in adults[J].BMJ, 2011, 343:d4331.

[4] 刘超,韩新巍.老年患者术后谵妄研究进展[J].实用医学杂志, 2013, 29(12): 1891-1893.

[5] David Meagher. Motor subtypes of delirium: past, present and future[J].Int Rev Psychiatry, 2009, 21(1):59-73.

[6] David Pfister, Martin Siegemund, Salome Dell-Kuster, et al. Cerebral perfusion in sepsis-associated delirium[J]. Crit Care, 2008, 12(3):R63.

[7] Barbara C van Munster, Catharina M Korse, Sophia E de Rooij, et al. Markers of cerebral damage during delirium in elderly patients with hip fracture[J].BMC Neurol,2009,9:1-7.

[8] Sebastian Koch, Alejandro Forteza, Carlos Lavernia, et al. Cerebral fat microembolism and cognitive decline after hip and knee replacement[J].Stroke, 2007, 38(3): 1079-1081.

[9] 李慧颖,陈琰,李学锋,等.术后谵妄病理生理机制的研究进展[J].中国老年学杂志, 2013, 33(22): 5777-5778.

[10] David R Janz, Ty W Abel, James C Jackson, et al. Brain autopsy findings in intensive care unit patients previously suffering from delirium: a pilot study[J].J Crit Care, 2010, 25(3): 538e7–e12.

[11] 杨娜瑜,姜丽华.老年患者术后谵妄的研究进展[J].临床麻醉学杂志, 2013, 10(29): 1039-1040.

[12] Luzius A Steiner. Postoperative delirium. Part 1: pathophysiology and risk factors[J].Eur J Anaesthesiol, 2011, 28(9):628-636.

[13] Niccolo Terrando, Claudia Monaco, Ma Da-qing, et al. Tumor necrosis factor-alpha triggers a cytokine cascade yielding postoperative cognitive decline[J].Proc Natl Acad Sci USA, 2010, 107(47): 20518-20522.

[14] Abraham Reichenberg, Raz Yirmiya, Andreas Schuld, et al. Cytokine-associated emotional and cognitive disturbances in humans[J].Arch Gen Psychiatry, 2001, 58(5):445-452.

[15] Sophia E de Rooij, Barbara C van Munster, Johanna C Korevaar, et al. Cytokines and acute phase response in delirium[J].J Psychosom Res, 2007, 62(5): 521-525.

[16] Han Ling, Jane McCusker, Martin Cole, et al. Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients[J].Arch Intern Med, 2001, 161(8): 1099-1105.

[17] Edward W Boyer, Michael Shannon. The serotonin syndrome[J].N Engl J Med, 2005, 352(11): 1112-1120.

[18] Rollin J Hawley, Charles B Nemeroff, Garth Bissette, et al. Neurochemical correlates of sympathetic activation during severe alcohol withdrawal[J].Alcohol Clin Exp Res, 1994, 18(6): 1312-1316.

[19] 蓝海珍, 于布为. 术后谵妄的研究进展[J].上海医学, 2013, 36(2): 161-164.

[20] Monidipa Dasgupta, Andrea C Dumbrell. Preoperative risk assessment for delirium after noncardiac surgery: a systematic review[J].J Am Geriatr Soc, 2006, 54(10): 1578-1259.

[21] Barbara C van Munster, Johanna C Korevaar, Aeiko H Zwinderman, et al. The association between delirium and the apolipoprotein E epsilon 4 allele: new study results and a meta-analysis[J].Am J Geriatr Psychiatry, 2009, 17(10): 856-862.

[22] Jakub Kazmierski, Maciej Kowman, Maciej Banach, et al. IPDACS Study.Incidence and predictors of delirium after cardiac surgery: Results from The IPDACS Study[J].J Psychosom Res, 2010, 69(2): 179-185.

[23] Sharon K Inouye. Delirium in older persons[J].N Engl J Med, 2006, 354(11): 1157-1165.

[24. 张伟英, 孙燕, 叶文琴. 冠状动脉旁路移植术后谵妄的研究进展[J].中华护理杂志, 2013, 9(48): 859-862.

[25] Pratik Pandharipande, Ayumi Shintani, Josh Peterson, et al. Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients[J].Anesthesiology, 2006, 104(1):21-26.

[26] Morrison R S, Magaziner J, Gilbert M, et al. Relationship between pain and opioid analgesics on the development of delirium following hip fracture[J].J Gerontol A Biol Sci Med Sci, 2003, 58(1): 76-81.

[27] Linnea E Vaurio, Laura P Sands, Wang Yun, et al. Postoperative delirium: the importance of pain and pain management[J].Anesth Analg, 2006, 102(4): 1267-1273.

[28] Anoushka Afonso, Corey Scurlock, David Reich, et al. Predictive model for postoperative delirium in cardiac surgical patients[J].Semin Cardiothorac Vasc Anesth, 2010, 14(3): 212-217.

[29] Gregory L Bryson, Anna Wyand. Evidence-based clinical update: general anesthesia and the risk of delirium and postoperative cognitive dysfunction[J].Can J Anaesth, 2006, 53(7):669-677.

[30] Frederick E Sieber, Khwaji J Zakriya, Allan Gottschalk, et al. Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair[J].Mayo Clin Proc, 2010, 85(1): 18-26.

[31] Richard N Jones, Frances M Yang, Zhang Ying, et al. Does educational attainment contribute to risk for delirium? A potential role for cognitive reserve[J].J Gerontol A Biol Sci Med Sci, 2006, 61(12):1307-1311.

[32] Frances M Yang, Sharon K Inouye, Michael A Fearing, et al. Participation in activity and risk for incident delirium[J].J Am Geriatr Soc, 2008, 56(8): 1479-1484.

[33] Robert S Wilson, Carlos F Mendes De Leon, Lisa L Barnes, et al. Participation in cognitively stimulating activities and risk of incident Alzheimer disease[J].JAMA, 2002, 287(6): 742-748.

[34] Brown T M, Boyle M F. Delirium[J].BMJ, 2002, 325(7365): 644-647.

[35] Sandeep Grover, Natasha Kate. Assessment scales for delirium: A review[J].J Psychiatry, 2012, 2(4): 58-70.

[36] Paula T Trzepacz, Dinesh Mittal, Rafael Torres, et al. Validation of the delirium rating scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium[J].J Neuropsychiatry Clin Neurosci, 2001, 13(2):229-242.

[37] Luzius A Steiner. Postoperative delirium. part 2: detection, prevention and treatment[J].Eur J Anaesthesiol, 2011, 28(10): 723-732.

[38] Dimitrios Adamis, Naveen Sharma, Paul J Whelan, et al. Delirium scales: A review of current evidence[J].Aging Ment Health, 2010, 14(5): 543-545.

[39] Sharon K Inouye, Sideny T Jr Bogardus, Peter A Charpentier, et al. A multicomponent intervention to prevent delirium in hospitalized older patients[J].N Engl J Med, 1999, 340(9): 669-676.

[40] Edward R Marcantonio, Jonathan M Flacker, R John Wright, et al. Reducing delirium after hip fracture: a randomized trial[J].J Am Geriatr Soc, 2001, 49(5): 516-522.

[41] Björkelund K B, Hommel A, Thorngren K G, et al. Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study[J].Acta Anaesthesiol Scand, 2010, 54(6):678-688.

[42] 李志鹏, 王飞. 右美托咪啶对脑神经保护机制的研究进展[J].医学综述, 2014, 21(20): 3947-3949.

[43] Richard R Riker, Yahya Shehabi, Paula M Bokesch, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial[J].JAMA, 2009, 301(5): 489-499.

[44] Jose R Maldonado, Ashley Wysong, Pieter J van der Starre, et al. Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery[J]. Psychosomatics, 2009, 50(3):206-217.

[45] Jen A Tan, Kwok M Ho. Use of dexmedetomidine as a sedative and analgesic agent in critically ill adult patients: a meta-analysis[J].Intensive Care Medicine, 2010, 36(6):926-939.

[46] Richard S Bourne, Gary H Mills. Melatonin: possible implications for the postoperative and critically ill patient[J].Intensive Care Medicine, 2006, 32(3): 371-379.

[47] Leung J M, Sands L P, Rico M, et al. Pilot clinical trial of gabapentin to decrease postoperative delirium in older patients[J].Neurology, 2006, 67(7): 1251-1253.

[48] Dallas P Seitz, Sudeep S Gill, Louis T van Zyl. Antipsychotics in the treatment of delirium: a systematic review[J].J Clin Psychiatry, 2007, 68(1): 11-21.

[49] William Breitbart, Rocco Marotta, Meredith M Platt, et al. A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients[J].Am J Psychiatry, 1996, 153(2): 231-237.

[50] Yoanna K Skrobik, Nicolas Bergeron, Marc Dumont, et al. Olanzapine vs haloperidol: treating delirium in a critical care setting[J].Intensive Care Med, 2004, 30(3):444-449.

[51] William Breitbart, Annie Tremblay, Christopher Gibson. An open trial of olanzapine for the treatment of delirium in hospitalized cancer patients[J]. Psychosomatics, 2002, 43(3):175-182.

[52] Soenke Boettger, William Breitbart. Atypical antipsychotics in the management of delirium: a review of the empirical literature[J].Palliat Support Care, 2005, 3(3): 227-237.

[53] Devlin J W, Roberts R J, Fong J J, et al. Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study[J].Crit Care Med, 2010, 38(2): 419-427.

[54] Maarten M J van Eijk, Kit C Roes, Marina L H Honing, et al. Effect of rivastigmine as an adjunct to usual care with haloperidol on duration of delirium and mortality in critically ill patients: a multicentre, double-blind, placebo-controlled randomised trial[J].Lancet, 2010, 376(9755): 1829-1837.

[55] Jacobi J, Fraser G L, Coursin D B, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult[J].Crit Care Med, 2002, 30(1): 119-141.

[56] Han Chang-su, Yong-Ku Kim. A double-blind trial of risperidone and haloperidol for the treatment of delirium[J].Psychosomatics, 2004, 45(4): 297-301.

[57] DeBellis R, Smith BS, Choi S, et al. Management of delirium tremens[J].J Intensive Care Med, 2005, 20(3): 164-173.

[58] Edmund Lonergan, Jay Luxenberg, Almudena Areosa Sastre. Benzodiazepines for delirium[J].Cochrane Database Syst Rev, 2009, 4:CD006379.

[59] Jane S Saczynski, Edward R Marcantonio, Lien Quach, et al. Cognitive trajectories after postoperative delirium[J]. N Engl J Med, 2012, 367(1):30-39.

[60] Joost Witlox, Lisa S M Eurelings, Jos F M de Jonghe, et al. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis[J].JAMA, 2010, 304(4): 443-451.

[61] William Breitbart, Christopher Gibson, Annie Tremblay. The delirium experience: delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers, and their nurses[J].Psychosomatics, 2002, 43(3): 183-194.

[62] Sebastien Ouimet, Richard Riker, Nicolas Bergeron, et al. Subsyndromal delirium in the ICU: evidence for a disease spectrum[J].Intensive Care Med, 2007, 33(6):1007-1013.

[63] Willem A van Gool, Diederik van de Beek, Piet Eikelenboom. Systemic infection and delirium: when cytokines and acetylcholine collide[J].Lancet, 2010, 375(9716): 773-775.

术后谵妄的研究进展

Research Progress of Postoperative Delirium

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章15

编辑推荐

Metrics

[1]	谢彬, 黄志源, 林多朵, 杨福龙, 谢奕彬.针药结合干预阿尔茨海默病抑郁症状效果分析[J]. 神经药理学报, 2020, 10(5): 5-8.
[2]	孙丽丛, 张丹参.生物碱类成分对阿尔茨海默症潜在治疗的研究进展[J]. 神经药理学报, 2020, 10(5): 33-37.
[3]	刘畅, 孟宪勇, 董晓华.阿尔茨海默症的发病机制及治疗药物研究进展[J]. 神经药理学报, 2020, 10(4): 36-40.
[4]	郭子霞, 安子璇, 张健美, 张丹参.药物治疗溃疡性结肠炎的信号通路研究进展[J]. 神经药理学报, 2020, 10(4): 41-50.
[5]	雷罗春, 艾瑛, 杨军英, 郑炜.ICU 常规与优化治疗对心脏骤停后综合征患者心肺、脑复苏情况的影响分析[J]. 神经药理学报, 2020, 10(4): 1-4.
[6]	杨旭华, 杜爽, 沈丽霞, 郝军荣.阿尔茨海默病的药物治疗研究进展[J]. 神经药理学报, 2020, 10(3): 47-53.
[7]	莫翠英, 骆国平.尼麦角林联合曲舍林及心理治疗对脑卒中后抑郁患者抑郁情绪的影响[J]. 神经药理学报, 2020, 10(2): 7-10.
[8]	刘璇, 滕金亮.右美托咪定对术后认知功能障碍影响的研究进展[J]. 神经药理学报, 2020, 10(2): 39-45.
[9]	林思梅, 周虹, 杨宝学.高尿酸血症与慢性肾脏病相关性研究进展[J]. 神经药理学报, 2020, 10(2): 55-64.
[10]	张丽环, 楚宝, 张晓燕, 孙莹茹, 宫春东, 王贺波.镁在偏头痛发病机制及治疗中的研究进展[J]. 神经药理学报, 2020, 10(1): 29-33.
[11]	何盼, 刘月涛, 杜冠华, 秦雪梅.肌少症研究进展[J]. 神经药理学报, 2020, 10(1): 47-53.
[12]	夏小雯, 宋春红, 乔明琦, 等.经前烦躁障碍症发生机制研究进展[J]. 神经药理学报, 2019, 9(6): 36-40.
[13]	刑媛，张楠,张炜，任雷鸣.局麻药的中枢神经系统毒性与防治[J]. 神经药理学报, 2018, 8(3): 15-.
[14]	朱敏1,李凌海2.麻醉药物应用与患者术后认知功能障碍的研究进展[J]. 神经药理学报, 2018, 8(3): 32-.
[15]	高志红，左亚奇，张晓丽.黄芪甲苷诱导骨髓间充质干细胞治疗帕金森病的新思路[J]. 神经药理学报, 2017, 7(5): 39-44.