切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 ›› 2017, Vol. 03 ›› Issue (04) : 286 -290. doi: 10.3877/cma.j.issn.2096-1537.2017.04.011

所属专题: 镇痛镇静 重症医学 文献

观点

镇静深浅与谵妄:有无因果?可否防治?
王春梅1, 黄华玮2, 周建新2,()   
  1. 1. 100050 首都医科大学附属北京天坛医院重症医学科;125001 辽宁省葫芦岛市中心医院重症医学科
    2. 100050 首都医科大学附属北京天坛医院重症医学科
  • 收稿日期:2017-05-19 出版日期:2017-11-28
  • 通信作者: 周建新

Causal relationship between sedation and delirium and how to prevent delirium in intensive care unit

Chunmei Wang1, Huawei Huang2, Jianxin Zhou2,()   

  1. 1. Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China; Department of Critical Care Medicine, Huludao Center Hospital, Liaoning 125001, China
    2. Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
  • Received:2017-05-19 Published:2017-11-28
  • Corresponding author: Jianxin Zhou
  • About author:
    Corresponding author: Zhou Jianxin, Email:
引用本文:

王春梅, 黄华玮, 周建新. 镇静深浅与谵妄:有无因果?可否防治?[J]. 中华重症医学电子杂志, 2017, 03(04): 286-290.

Chunmei Wang, Huawei Huang, Jianxin Zhou. Causal relationship between sedation and delirium and how to prevent delirium in intensive care unit[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2017, 03(04): 286-290.

ICU谵妄是危重症诊疗中的常见并发症,是一种急性、波动性、非特异性脑功能障碍,主要表现为意识和认知程度的改变。ICU谵妄发生率高,常导致患者住院病死率增加,住院时间延长,医疗费用增加,不良转归增多。镇静作为ICU内常见治疗模式,是否会增加患者谵妄发生风险,镇静深浅与谵妄是否存在因果关系,对谵妄应如何进行防治,逐渐被临床所关注。本文将从镇静与谵妄的发生关系及谵妄的防治进展方面作一综述。

Delirium is an acute, non-specific cerebral impairment characterized by a change consciousness and cognition. The incidence of delirium is high in ICU, which is critically associated with increased mortality, duration of hospital stay and medical costs. As a widely used strategy in ICU, weather sedation increases the risk of delirium as well as the causative relationship between the sedative depth and delirium and prevention of delirium have drwan more and more attention in ICU. In this paper, we review the relationship between sedation and delirium, the prevention and treatment of delirium were also discussed in this review.

1
Ely EW, Siegel MD, Inouye SK. Delirium in the intensive care unit: an under-recognized syndrome of organ dysfunction [J]. Semin Respir Crit Care Med, 2001, 22(2):115-126.
2
Pandharipande P, Jackson J, Ely EW. Delirium: acute cognitive dysfunction in the critically ill [J]. Curr Opin Crit Care, 2005, 11(4):360-368.
3
Thomason JW, Shintani A, Peterson JF, et al. Intensive care unit delirium is an independent predictor of longer hospital stay: a prospective analysis of 261 non-ventilated patients [J]. Crit Care, 2005, 9(4):R375-381.
4
Milbrandt EB, Deppen S, Harrison PL, et al. Costs associated with delirium in mechanically ventilated patients [J]. Crit Care Med, 2004, 32(4):955-962.
5
Ouimet S, Kavanagh BP, Gottfried SB, et al. Incidence, risk factors and consequences of ICU delirium [J]. Intensive Care Med, 2007, 33(1):66-73.
6
Kamdar BB, Niessen T, Colantuoni E, et al. Delirium transitions in the medical ICU: exploring the role of sleep quality and other factors [J]. Crit Care Med, 2015, 43(1):135-141.
7
Seymour CW, Pandharipande PP, Koestner T, et al. Diurnal sedative changes during intensive care: impact on liberation from mechanical ventilation and delirium [J]. Crit Care Med, 2012, 40(10):2788-2796.
8
Devlin JW, Bhat S, Roberts RJ, et al. Current perceptions and practices surrounding the recognition and treatment of delirium in the intensive care unit: a survey of 250 critical care pharmacists from eight states [J]. Ann Pharmacother, 2011, 45(10):1217-1229.
9
Fraser GL, Devlin JW, Worby CP, et al. Benzodiazepine versus nonbenzodiazepine-based sedation for mechanically ventilated, critically ill adults: a systematic review and meta-analysis of randomized trials [J]. Crit Care Med, 2013, 41(9 Suppl):S30-S38.
10
Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit [J]. Crit Care Med, 2013, 41(1):263-306.
11
Shehabi Y, Bellomo R, Mehta S, et al. Intensive care sedation: the past, present and the future [J]. Crit Care, 2013, 17(3):322-329.
12
Riker RR, Shehabi Y, Bokesch PM, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial [J]. JAMA, 2009, 301(5):489-499.
13
Jakob SM, Ruokonen E, Grounds RM, et al. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials [J]. JAMA, 2012, 307(11):1151-1160.
14
Su X, Meng ZT, Wu XH, et al. Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial [J]. Lancet, 2016, 388(10054):1893-1902.
15
Kawazoe Y, Miyamoto k, Morimoto T, et al. Effect of dexmedetomidine on mortality and ventilator-free days in patients requiring mechanical ventilation with sepsis: a randomized clinical trial [J]. JAMA, 2017, 317(13):1321-1328.
16
Skrobik Y, Leger C, Cossette M, et al. Factors predisposing to coma and delirium: fentanyl and midazolam exposure; CYP3A5, ABCB1, and ABCG2 genetic polymorphisms; and inflammatory factors [J]. Crit Care Med, 2013, 41(4):999-1008.
17
Zaal IJ, Devlin JW, Hazelbag M, et al. Benzodiazepine-associated delirium in critically ill adults [J]. Intensive Care Med, 2015, 41(12):2130-2137.
18
American Society of Anesthesiologists. Continuum of depth of sedation: definition of general anesthesia and levels of sedation/analgesia [DB/OL]. 1999(2014-10-15)[2017-05-19].

URL    
19
Shehabi Y, Bellomo R, Reade MC, et al. Early intensive care sedation predicts long-term mortality in ventilated critically ill patients [J]. Am J Respir Crit Care Med, 2012, 186(8):724-731.
20
Tanaka LM, Azevedo LC, Park M, et al. Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study [J]. Crit Care, 2014, 18(4):R156.
21
Ely EW. Confusion Assessment Method for the ICU (CAM-ICU) the complete training manual.

URL    
22
Sieber FE, Zakriya KJ, Gottschalk A, et al. Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair [J]. Mayo Clin Proc, 2010, 85(1):18-26.
23
Moyce Z, Rodseth RN, Biccard BM. The efficacy of peri-operative interventions to decrease postoperative delirium in non-cardiac surgery: a systematic review and meta-analysis [J]. Anaesthesia, 2014, 69(3):259-269.
24
DAS-Taskforce 2015, Baron R, Binder A, et al. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine [J]. Ger Med Sci, 2015, 13:Doc 19.
25
Haenggi M, Blum S, Brechbuehl R, et al. Effect of sedation level on the prevalence of delirium when assessed with CAM-ICU and ICDSC [J]. Intensive Care Med, 2013, 39(12):2171-2179.
26
Mehta S, Burry L, Cook D, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial [J]. JAMA, 2012, 308(19):1985-1992.
27
van den Boogaard M, Schoonhoven L, van Achterberg T. Haloperidol prophylaxis in critically ill patients with a high risk for delirium [J]. Crit Care, 2013, 17(1):R9.
28
Girard TD, Pandharipande PP, Carson SS, et al. Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial [J]. Crit Care Med, 2010, 38(2):428-437.
29
Al-Qadheeb NS, Skrobik Y, Schumaker G, et al. Preventing ICU subsyndromal delirium conversion to delirium with low dose IV haloperidol: a double-blind, placebo-controlled pilot study [J]. Crit Care Med, 2016, 44(3):583-591.
30
Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people [J]. Lancet, 2014, 383(9920):911-922.
31
Huang H, Jiang L, Shen L, et al. Impact of oral melatonin on critically ill adult patients with ICU sleep deprivation: study protocol for a randomized controlled trial [J]. Trials, 2014, 15:327.
32
Al-Aama T, Brymer C, Gutmanis I, et al. Melatonin decreases delirium in elderly patients: a randomized, placebo-controlled trial [J]. Int J Geriatr Psychiatry, 2011, 26(7):687-694.
33
Sultan SS.Assessment of role of perioperative melatonin in prevention and treatment of postoperative delirium after hip arthroplasty under spinal anesthesia in the elderly [J].Saudi J Anaesth, 2010, 4(3):169-173.
34
Hipp DM, Ely EW. Pharmacological and nonpharmacological management of delirium in critically ill patients [J]. Neurotherapeutics, 2012, 9(1):158-175.
35
Vasilevskis EE, Pandharipande PP, Girard TD, et al. A screening, prevention, and restoration model for saving the injured brain in intensive care unit survivors [J]. Crit Care Med, 2010, 38(10 Suppl):S683-S691.
36
Balas MC, Vasilevskis EE, Olsen KM, et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle [J]. Crit Care Med, 2014, 42(5):1024-1036.
37
Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial [J]. Lancet, 2009, 373(9678):1874-1882.
38
Needham DM, Korupolu R, Zanni JM, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project [J]. Arch Phys Med Rehabil, 2010, 91(4):536-542.
39
Vincent JL, Shehabi Y, Walsh TS, et al. Comfort and patient-centred care without excessive sedation: the eCASH concept [J]. Intensive Care Med, 2016, 42(6):962-971.
[1] 杨菲菲, 林锡祥, 陈亦新, 王秋霜, 张丽伟, 陈煦, 张梅青, 王淑华, 何昆仑. 基于深度学习的超声心动图自动识别节段性室壁运动异常的研究[J]. 中华医学超声杂志(电子版), 2023, 20(04): 424-429.
[2] 唐玮, 何融泉, 黄素宁. 深度学习在乳腺癌影像诊疗和预后预测中的应用[J]. 中华乳腺病杂志(电子版), 2023, 17(06): 323-328.
[3] 李锐颖, 危望, 王达志, 时志斌. 深度学习技术在膝关节疾病中的研究现状与展望[J]. 中华关节外科杂志(电子版), 2023, 17(05): 722-725.
[4] 徐娟, 孙汝贤, 赵东亚, 张清艳, 金兆辰, 蔡燕. 右美托咪定序贯镇静模式对中深度镇静的机械通气患者预后和谵妄的影响[J]. 中华危重症医学杂志(电子版), 2023, 16(05): 363-369.
[5] 李晓阳, 刘柏隆, 周祥福. 大数据及人工智能对女性盆底功能障碍性疾病的诊断及风险预测[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 549-552.
[6] 张磊, 米洋, 王昌喜, 李曜行, 王小东, 牛旭东, 王靖宇. 一次性输尿管软镜通路鞘两种置入深度的临床研究[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 486-489,494.
[7] 于智慧, 赵建军. 后路腰方肌阻滞复合全身麻醉在腹股沟斜疝经腹腹膜前手术中的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 734-739.
[8] 田静, 方秀春. 超声引导下横筋膜平面阻滞在儿童腹股沟疝手术的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 740-744.
[9] 黄铁刚, 肖凤霞. 地塞米松联合罗哌卡因在腹股沟疝修补术后镇痛效果及对血清指标的影响[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 574-578.
[10] 谢文龙, 周建军. 超声引导下髂腹股沟-髂腹下神经阻滞联合腹横肌平面阻滞在老年腹股沟疝中的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 588-592.
[11] 段文忠, 白延霞, 徐文亭, 祁虹霞, 吕志坚. 七氟烷和丙泊酚在肝切除术中麻醉效果比较Meta分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 640-645.
[12] 雷漫诗, 邓锶锶, 汪昕蓉, 黄锦彬, 向青, 熊安妮, 孟占鳌. 人工智能辅助压缩感知技术在上腹部T2WI压脂序列中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 551-556.
[13] 韩冰, 顾劲扬. 深度学习神经网络在肝癌诊疗中的研究及应用前景[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 480-485.
[14] 葛云鹏, 崔红元, 宋京海. 人工智能在原发性肝癌诊断、治疗及预后中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(04): 367-371.
[15] 徐洪宇, 何亚爽. 羟考酮与氢吗啡酮用于胃癌根治术后镇痛的疗效[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 312-316.
阅读次数
全文


摘要