理清谵妄的脉络:综述谵妄的多面性和诊断的复杂性

Luisa Fernanda Montoya Arrieta
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引用次数: 0

摘要

谵妄的预防涉及多方面的策略,通过非药物干预措施针对可改变。定向协议、认知刺激、改善睡眠、早期动员和尽量减少身体束缚是关键的组成部分。此外,应对药物相关风险和及时处理医疗并发症也是至关重要的预防措施。在谵妄管理中,识别和治疗潜在病症、提供支持性医疗护理和控制躁动至关重要。抗精神病药物、苯二氮卓类药物和胆碱酯酶抑制剂具有特殊c 作用,但要谨慎考虑潜在风险。疼痛管理,尤其是使用非阿片类镇痛药,起着至关重要的作用。伦理方面的考虑,包括知情同意和尊重患者的偏好,是治疗方法不可或缺的一部分。谵妄的后果非常严重,影响患者的住院时间延长、功能和认知能力下降、死亡率升高,并增加了入院治疗的风险。即使在调整了混杂因素后,与谵妄相关的死亡率仍然很高,因此谵妄是住院后死亡率的一个独立标志。持续的认知功能障碍,尤其是伴有潜在痴呆症的患者,是一个令人担忧的长期结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
UNTANGLING THE THREADS OF DELIRIUM: A REVIEW ON ITS MULTIFACETED NATURE AND DIAGNOSTIC COMPLEXITIES
Delirium prevention involves multifaceted strategies, targeting modiable risk factors through nonpharmacologic interventions. Orientation protocols, cognitive stimulation, sleep enhancement, early mobilization, and minimizing physical restraints are key components. Additionally, addressing medication-related risks and prompt management of medical complications are crucial preventive measures. In delirium management, identifying and treating underlying conditions, providing supportive medical care, and managing agitation are essential. Antipsychotic medications, benzodiazepines, and cholinesterase inhibitors have specic roles, with cautious consideration of potential risks. Pain management, especially with nonopioid analgesics, plays a pivotal role. Ethical considerations, including informed consent and respecting patient preferences, are integral to the treatment approach. Delirium outcomes are severe, impacting older individuals with prolonged hospitalizations, functional and cognitive decline, elevated mortality rates, and an increased risk of institutionalization. Mortality associated with delirium remains high even after adjusting for confounding factors, making it an independent marker for post-hospitalization mortality. Persistent cognitive dysfunction, particularly in those with underlying dementia, is a concerning long-term outcome.
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