谵妄的诊断与治疗进展

The Diagnosis and Treatment of Delirium

谵妄是老年患者较常见的病症，但易被误诊。谵妄是意识、定向力、记忆力、思维、感知能力及行为等方面出现紊乱的一种精神障碍。其特点足急性发病及波动性病程。50％以上的住院患者可出现谵妄，临床表现为活动过度型、活动减退型及混合型三种类型。谵妄可发生于痴呆早期，其与功能性障碍、住院时间增加、长期护理时间延长、病死率及住院费用增长呈独立相关。尽管现在已认识到谵妄的重要性，并且实行护理筛选及危险因素评估等措施，以及已有的诊断及砰估方法，但谵妄在临床中仍存在漏诊及误诊的情况。虽然谵妄的病因、发病机制、诊断及治疗等方面进展有限，但谵妄的系统性诊断与治疗方法对老年患者治疗有益，其预防性措施对老年内科与外科住院患者亦有帮助。

Delirimn is common disease among elderly patients but the diagnosis is frequently missed. Delirium is a mental disor- der characterized by acute onset and fluctuating course and disturbances in consciousness, orientation, memory, thought, perception and behavior. It occurs in hyperactive, hypoactive or mixed forms. Up to 50% of elderly hospital inpatients has delirium. Many patients have pre -existing dementia and appear to be imtependently associated with significant increases in functional disability, length of hospital stay, rates of admission to long - term care institutions, rates of death and heahhcare costs. Delirium is often not detected or it is misdiagnosed as dementia or other psychiatric illness even though there are potential strategies （ e. g. , screening by nurses, risk - factor assessment） and instruments that can improve detection and diagnosis. Although there has been limited progress in understanding the etiology, pathogenesis, assessment, and specific treatment of delirium, systematic detection and treatment programs appear to be beneficial for elderly patients.