危重症儿童谵妄评估工具研究现状

Review of delirium assessment tools in pediatric intensive care units

谵妄常常伴随病死率升高、住院时间延长和认知缺损等不良结局,因而危重症患者在重症监护病房(ICU)期间的谵妄问题越来越受到医护人员的关注。目前,国内外专业学会已发布了成人谵妄相关的临床指南,成人谵妄的诊疗已逐步规范化。然而,在儿科领域,谵妄仍未引起医护人员的重视,相关研究少,评估诊断工具尚未统一。由于儿童认知、行为表现不同于成人,因而在儿科领域使用成人谵妄评估工具(如CAM-ICU)存在一定制约。该文主要就文献回顾中所提及的儿童谵妄评估工具,如pCAM-ICU、PAED等进行特点及应用情况分析,以期为早日开展危重症儿童谵妄的评估工作提供参考。

Delirium is always associated with high mortality, prolonged length of stay in intensive care unit （ICU）, post- ICU cognitive impairment, and other adverse outcomes, so that it arouses medical staffs＇ concerns for critical patients recently. Both Chinese and American Critical Care Associations have published clinical guidelines of delirium management in adult ICU, which make the diagnosis and treatment of delirium standardization gradually. However, there is still lack of attention and researches in pediatric ICU. Assessment or diagnostic tools for pediatric delirium are still inconsistent. Because children＇s cognition and behavior are different from adults＇, there is a limit to directly apply the adult delirium assessment tools （e. g. CAM-ICU） to pediatric patients. In this paper, we reviewed the pediatric delirium assessment tools, and summarized the characteristics and applications of these tools （e. g. pCAM-ICU, PAED）, in order to provide references to deliver the assessment of pediatric delirium as soon as possible.