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: 重症医学 文献资源库

观点 上一篇    下一篇

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 Wang 1, Huawei Huang 2, Jianxin Zhou 2 , ( )   

  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:

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] 李广涵, 刘健, 马立勇, 董梦超, 武敬平, 张波, 李文歌, 郑敏. 基于深度学习的超声影像诊断对终末期慢性肾病的价值[J]. 中华医学超声杂志(电子版), 2021, 18(06): 611-615.
[2] 郭爽萍, 倪东, 尚宁, 王丽敏, 胡歆迪, 吕栩再, 梁永栋. 基于深度学习的人工智能测量婴儿非偏心型髋关节的研究[J]. 中华医学超声杂志(电子版), 2021, 18(05): 467-471.
[3] 邢家诚, 闫石, 蔡莉. 深度学习在乳腺X线摄影中的应用[J]. 中华乳腺病杂志(电子版), 2021, 15(04): 238-241.
[4] 李想, 李世傲, 钱嘉天, 钱齐荣, 符培亮. 两种镇痛方法对全膝关节置换术后康复的影响[J]. 中华关节外科杂志(电子版), 2021, 15(02): 178-184.
[5] 杨钦烽, 王健, 张洋, 史占军, 徐一川, 陈雨航, 廉强. 美国住院病人髋膝关节置换术后谵妄发生率及危险因素[J]. 中华关节外科杂志(电子版), 2021, 15(01): 57-63.
[6] 季春莲, 孟建标, 沈莹, 张微, 庞丽莎, 徐敏荣. 奥氮平治疗ICU内谵妄患者的疗效分析[J]. 中华危重症医学杂志(电子版), 2021, 14(02): 146-148.
[7] 宫丹丹, 徐爽, 姜晓东, 于健. 右美托咪定抑制脓毒症患者炎症反应的可能机制及剂量相关性研究[J]. 中华危重症医学杂志(电子版), 2021, 14(01): 10-14.
[8] 周红玉, 李羽. 右美托咪定在儿童患者麻醉中的应用[J]. 中华妇幼临床医学杂志(电子版), 2021, 17(04): 482-487.
[9] 刘琰, 方培耀. 守正创新 砥砺前行[J]. 中华损伤与修复杂志(电子版), 2021, 16(03): 203-207.
[10] 张铭, 陈铭锐. 氟比洛芬酯注射液用于烧伤患者镇痛的研究进展[J]. 中华损伤与修复杂志(电子版), 2021, 16(02): 143-146.
[11] 佘杨杨, 陈洁玉, 高峰, 江静薇, 张敏, 葛雅平. 深度学习在口腔颌面部影像诊断领域的研究进展[J]. 中华口腔医学研究杂志(电子版), 2021, 15(03): 185-188.
[12] 作者. 器官移植常见精神系统并发症[J]. 中华移植杂志(电子版), 2021, 15(03): 0-.
[13] 刘春宏, 尹利群, 刘夏曦, 王中清, 胡庆波, 杨晓云. 纳布啡超前镇痛对胸腔镜肺癌根治术患者术后认知功能及PMN、ADP的影响[J]. 中华肺部疾病杂志(电子版), 2021, 14(03): 355-357.
[14] 吴晓, 岳永飞, 黎婷, 汪云, 曲云. 椎管内分娩镇痛对瘢痕子宫阴道分娩的影响[J]. 中华产科急救电子杂志, 2021, 10(03): 179-183.
[15] 彭冲, 卢芳燕, 孙军辉. 基于快速康复外科的多模式镇痛在肝动脉化疗栓塞术中的应用[J]. 中华介入放射学电子杂志, 2021, 09(02): 215-219.
阅读次数
全文


摘要