急诊谵妄患者的诊断和治疗

Diagnosis and treatment of delirium in emergency room

谵妄是一种老年患者在急诊就诊和住院期间常见的临床综合征,在术后和急诊就诊的老年患者中具有很高的发病率,其起病迅速,一天中病程常呈波动性.谵妄是一种可危及生命的急诊情况,需要迅速诊断并评估,寻找并治疗引起谵妄的潜在疾病.谵妄的处理关键在于预防,要尽量去除可能诱发谵妄的危险因素.治疗谵妄的药物对老年患者不良反应较大,因此只有在症状持续不能控制,患者有自伤、伤人以及干扰治疗的倾向时才建议小心使用.国外文献报道谵妄在急诊的漏诊率很高,这主要与急诊医师没有受过相关培训并且不常规筛查谵妄有关.对急诊工作人员进行必要的培训,有助于改善谵妄患者的病死率.

Delirium is common in hospitalized elderly patients as well as in emergency room （ER） and it may also be the main cause of emergency visiting. It is characterized by an acute change in cognition and attention, although the symptoms may he subtle and usually fluctuate throughout the day. This severe syndrome requires prompt recognition and evaluation, because the underlying disease may be life threatening, and delirium may be the only syndrome that can be observed. The key point of management for delirium is to prevent the risk factors. Once it happens, physicians in Ell must seek and release the underlying diseases promptly. Nonpharmacologie interventions may be beneficial, but antipsyehotic agents may be needed when the cause is nonspecifie and other interventions do not sufficiently control symptoms although they may have especially many adverse effects to elderly patients. The undetected rate of delirium is especially high in ER according to foreign literatures, since ER physicians dont receive related training and dont screen it regularly. So, such training as to detect and manage delirium is needed to decrease the higher mortality rate of delirious patients.