老年患者术后谵妄术前预测的研究进展

Research progress on early prediction of postoperative delirium in elderly patients

术后谵妄(POD)是老年患者手术后常见的严重并发症,可导致住院时间延长、病死率增加。术前早期预测POD有助于减少或逆转其发生,对改善患者预后及减轻社会负担具有重要意义。当前对POD预测方法有限,且存在诸多不足。评估筛查量表是临床常用诊断及预测POD的工具,预测价值较高,但专业程度要求高;现病史仅可简单评估POD高危人群;生物标志物可反映神经病变或损伤程度,体现出较高的POD预测价值,但种类较多,缺乏统一客观指标;影像学及神经电生理检查,可反映脑功能状况,具备一定的预测价值,其适应证人群尚无明确标准;大数据分析、计算机应用程序已被用于预测谵妄,体现出较高的临床价值,但简单实用、准确高效且易于医务人员掌握的工具尚需进一步开发。

Postoperative delirium(POD)is a common serious complication in elderly patients after surgery,which can lead to prolonged hospital stay and increased mortality.Early preoperative prediction of POD can help reduce or reverse its occurrence,and is of great significance for improving patient prognosis and reducing social burden.The current methods for predicting POD are limited and have many shortcomings.The evaluation screening scale is a commonly used tool for clinical diagnosis and prediction of POD,with high predictive value but high professional requirements.The current medical history can only be briefly evaluated for high-risk individuals with POD.Biomarkers can reflect the degree of neuropathy or injury and have high predictive value for POD,but there are many types and there is a lack of unified objective indicators.Imaging and neuroelectrophysiological examinations can reflect the state of brain function and have certain predictive value,but there is no clear standard for their adaptation to the witness group.Big data analysis and computer applications have been used to predict delirium,demonstrating high clinical value.However,tools that are simple,practical,accurate,efficient,and easy for medical personnel to master still need further development.