摘要
谵妄是ICU中常见的一种急性临床综合征,可导致患者病死率增加,机械通气时间和住院时间延长,引起长期的认知功能障碍,增加医疗费用,严重影响患者的预后。为规范重症患者的谵妄管理,由中国冷静治疗研究组根据国内外最新文献资料和多年来的应用推广经验,组织相关重症医学专家在充分讨论和沟通基础上制定了"重症患者谵妄管理专家共识"。旨在改进重症患者的谵妄管理,优化镇痛镇静治疗,改善患者的预后。
To establish the experts consensus on the management of delirium in critically ill patients. A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group. Each statement was assessed based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) principle. Then the Delphi method was adopted by 36 experts to reassess all the statements. (1) Delirium is not only a mental change, but also a clinical syndrome with multiple pathophysiological changes. (2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function. (3) Pain is a common cause of delirium in critically ill patients. Analgesia can reduce the occurrence and development of delirium. (4) Anxiety or depression are important factors for delirium in critically ill patients. (5) The correlation between sedative and analgesic drugs and delirium is uncertain. (6) Pay attention to the relationship between delirium and withdrawal reactions. (7) Pay attention to the relationship between delirium and drug dependence/withdrawal reactions. (8) Sleep disruption can induce delirium. (9) We should be vigilant against potential risk factors for persistent or recurrent delirium. (10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases, and can also be alleviated with the improvement of primary diseases. (11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis. (12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium, especially subclinical delirium. (13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium. (14) Daily assessment is helpful for early detection of delirium. (15) Hopoactive delirium and mixed delirium are common and should be emphasized. (16) Delirium may be accompanied by changes in electroencephalogram
作者
汤铂
王小亭
陈文劲
朱世宏
晁彦公
朱波
何伟
王滨
曹芳芳
刘轶君
范晓静
杨翃
许强宏
张恒
龚瑞琛
柴文昭
张宏民
石广志
李立宏
黄齐兵
张丽娜
尹万红
尚秀玲
王晓猛
田方
刘丽霞
朱然
武钧
吴娅秋
李春玲
宗媛
胡军涛
刘娇
翟茜
邓丽静
邓一芸
刘大为
Tang Bo;Wang Xiaoting;Chen Wenjin;Zhu Shihong;Chao Yangong;Zhu Bo;He Wei;Wang Bin;Cao Fangfang;Liu Yijun;Fan Xiaojing;Yang Hong;Xu Qianghong;Zhang Heng;Gong Ruichen;Chai Wenzhao;Zhang Hongmin;Shi Guangzhi;Li Lihong;Huang Qibing;Zhang Lina;Yin Wanhong;Shang Xiuling;Wang Xiaomeng;Tian Fang;Liu Lixia;Zhu Ran;Wu Jun;Wu Yaqiu;Li Chunling;Zong Yuan;Hu Juntao;Liu Jiao;Zhai Qian;Deng Lijing;Deng Yiyun;Liu Dawei(Department of Critical Care Medicine,Peking Union Medical College Hospital,Peking Union Medical College, Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Critical Care Medicine,Zhejiang Hospital,Hangzhou 310013,China;Department of Neurosurgery,the First Hospital of China Medical Uinversity,Shenyang 110001,China;Department of Critical Care Medicine, Affiliated Hospital of Taiwan Kaohsinag University,China;Department of Critical Care Medicine,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China;Department of Neurosurgery,Tangdu Hospital,Air Force Military Medical University,Xi'an 710000,China;Department of Neurosurgery,Qilu Hospital of Shandong University,Jinan 250012,China;Department of Critical Care Medicine,Xiangya Hospital Central South University,Changsha 410008,China;Department of Critical Care Medicine,West China Hospital,Sichuaa University,Sichuan 610041,China;Department of Critical Care Medicine,Fujian Provincial Hospital,Fuzhou 350001,China;Department of Critical Care Medicine,Xuzhou Central Hospital, Xuzhou 221009,China;Department of Neurosurgery ICU,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Critical Care Medicine,Baoan People's Hospital of Shenzhen,Shenzhen 518101,China;Department of Critical Care Medicine,the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011,China;Department of Critical Care Medicine,the First Hospital of China Medical Uinversity,Shenyang 110001,China;Department of Critical Care Medicine,Ruijin Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200025,China;Department of Critical Care
出处
《中华内科杂志》
CAS
CSCD
北大核心
2019年第2期108-118,共11页
Chinese Journal of Internal Medicine
关键词
谵妄
重症
Delirium
Critical care
