老年危重患者术后谵妄的预防

Prophylaxis of postoperative delirium in elderly critically ill patients

背景谵妄与老年患者术后病死率的上升有很大关系，且治疗效果欠佳。因此，研究ICU中老年危重患者术后谵妄的预防就显得尤为重要。然而，现有的医疗手段都不是预防谵妄最合适的方法。目的就近年来老年危重患者术后谵妄预防的研究进展进行综述。内容围绕老年危重患者术后谵妄的预防，分别介绍氟哌啶醇、非典型抗精神病药物、右美托咪定、褪黑素及一些非药物处理的预防性应用。趋向目前最多的证据指向药物预防术后谵妄，并且抗精神病药物和右美托咪定在ICU的使用已经基本达到了共识。

Background Delirium is associated with substantial morbidity in elderly hospitalized patients, while since diagnosed, the delirium has scarcely been effectively treated. Therefore, it is of great importance to prevent postoperative delirium in elderly patients who are admitted to ICU. However, currently available treatments cannot optimally prevent the development of delirium in these patients. Objective To review the intervention strategies to prevent the postoperative delirium in elderly critically ill patients. Content To prevent postoperative delirium in elder patients in ICU, some clinical study centers used pharmacological （haloperidol, atypical antipsychotics, dexmedetomidine, melatonin） or non-pharmacological （reorientation, entertainment, family support, etc） strategies. Some of the drugs not only could reduce risk of post-operative delirium, but also cause emotional, cardiac or circadian side-effects. Trend The use of antipsychotics and dexmedetomidine has consensus efficacy to reduce the risk of postoperative delirium in elderly critically ill patients. However, further investigations are warranted to optimize the medication to mitigate their cardiac side-effects.