当前位置: X-MOL 学术Anaesthesia › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Evidence-based strategies to reduce the incidence of postoperative delirium: a narrative review.
Anaesthesia ( IF 7.5 ) Pub Date : 2022-01-01 , DOI: 10.1111/anae.15607
C J Swarbrick 1 , J S L Partridge 2
Affiliation  

Delirium is one of the most commonly occurring postoperative complications in older adults. It occurs due to the vulnerability of cerebral functioning to pathophysiological stressors. Identification of those at increased risk of developing delirium early in the surgical pathway provides an opportunity for modification of predisposing and precipitating risk factors and effective shared decision-making. No single delirium prediction tool is used widely in surgical settings. Multi-component interventions to prevent delirium involve structured risk factor modification supported by geriatrician input; these are clinically efficacious and cost effective. Barriers to the widespread implementation of such complex interventions exist, resulting in an 'implementation gap'. There is a lack of evidence for pharmacological prophylaxis for the prevention of delirium. Current evidence suggests that avoidance of peri-operative benzodiazepines, careful titration of anaesthetic depth guided by processed electroencephalogram monitoring and treatment of pain are the most effective strategies to minimise the risk of delirium. Addressing postoperative delirium requires a collaborative, whole pathway approach, beginning with the early identification of those patients who are at risk. The research agenda should continue to examine the potential for pharmacological prophylaxis to prevent delirium while also addressing how successful models of delirium prevention can be translated from one setting to another, underpinned by implementation science methodology.

中文翻译:

减少术后谵妄发生率的循证策略:叙述性回顾。

谵妄是老年人最常见的术后并发症之一。它的发生是由于大脑功能对病理生理应激源的脆弱性。识别在手术路径早期发生谵妄风险增加的人,为修改易感和诱发风险因素以及有效的共同决策提供了机会。没有一种单一的谵妄预测工具被广泛用于外科手术环境中。预防谵妄的多组分干预措施涉及由老年科医生支持的结构化风险因素修改;这些在临床上有效且具有成本效益。广泛实施此类复杂干预措施存在障碍,导致“实施差距”。缺乏药物预防谵妄的证据。目前的证据表明,避免围手术期使用苯二氮卓类药物、在经过处理的脑电图监测指导下仔细调整麻醉深度和治疗疼痛是降低谵妄风险的最有效策略。解决术后谵妄需要一种协作的、全路径的方法,从早期识别有风险的患者开始。研究议程应继续检查药物预防预防谵妄的潜力,同时还要解决谵妄预防的成功模式如何从一种环境转化为另一种环境,并以实施科学方法为基础。目前的证据表明,避免围手术期使用苯二氮卓类药物、在经过处理的脑电图监测指导下仔细调整麻醉深度和治疗疼痛是降低谵妄风险的最有效策略。解决术后谵妄需要一种协作的、全路径的方法,从早期识别有风险的患者开始。研究议程应继续检查药物预防预防谵妄的潜力,同时还要解决谵妄预防的成功模式如何从一种环境转化为另一种环境,并以实施科学方法为基础。目前的证据表明,避免围手术期使用苯二氮卓类药物、在经过处理的脑电图监测指导下仔细调整麻醉深度和治疗疼痛是降低谵妄风险的最有效策略。解决术后谵妄需要一种协作的、全路径的方法,从早期识别有风险的患者开始。研究议程应继续检查药物预防预防谵妄的潜力,同时还要解决谵妄预防的成功模式如何从一种环境转化为另一种环境,并以实施科学方法为基础。在经过处理的脑电图监测和疼痛治疗的指导下仔细滴定麻醉深度是降低谵妄风险的最有效策略。解决术后谵妄需要一种协作的、全路径的方法,从早期识别有风险的患者开始。研究议程应继续检查药物预防预防谵妄的潜力,同时还要解决谵妄预防的成功模式如何从一种环境转化为另一种环境,并以实施科学方法为基础。在经过处理的脑电图监测和疼痛治疗的指导下仔细滴定麻醉深度是降低谵妄风险的最有效策略。解决术后谵妄需要一种协作的、全路径的方法,从早期识别有风险的患者开始。研究议程应继续检查药物预防预防谵妄的潜力,同时还要解决谵妄预防的成功模式如何从一种环境转化为另一种环境,并以实施科学方法为基础。
更新日期:2022-01-01
down
wechat
bug