[1]唐 莉,王 强,颜 飞.围手术期谵妄发病机制及药物预防的研究[J].医学信息,2020,33(22):51-54.[doi:10.3969/j.issn.1006-1959.2020.22.016]
 TANG Li,WANG Qiang,YAN Fei.Study on the Pathogenesis and Drug Prevention of Delirium During Perioperative Period[J].Medical Information,2020,33(22):51-54.[doi:10.3969/j.issn.1006-1959.2020.22.016]
点击复制

围手术期谵妄发病机制及药物预防的研究()

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
33卷
期数:
2020年22期
页码:
51-54
栏目:
综述
出版日期:
2020-11-15

文章信息/Info

Title:
Study on the Pathogenesis and Drug Prevention of Delirium During Perioperative Period
文章编号:
1006-1959(2020)22-0051-04
作者:
唐 莉王 强颜 飞
(1.西安医学院第一附属医院麻醉科,陕西 西安 710021;2.西安交通大学第一附属医院麻醉科,陕西 西安 710061)
Author(s):
TANG LiWANG QiangYAN Fei
(1.Department of Anesthesiology,the First Affiliated Hospital of Xi’an Medical University,Xi’an 710021,Shaanxi,China;2.Department of Anesthesiology, the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,Shaanxi,China)
关键词:
术后谵妄发病机制药物预防
Keywords:
Postoperative deliriumPathogenesisDrug prevention
分类号:
R65
DOI:
10.3969/j.issn.1006-1959.2020.22.016
文献标志码:
A
摘要:
谵妄是一种急性、波动性的疾病,以兴奋性增高为主,表现为思维紊乱、定向力障碍、注意力不集中、昼夜颠倒、意识改变等症状,可导致术后并发症增多、增加围手术期死亡率,但目前对术后谵妄的发病机制的研究尚存在争议,其治疗仍主要以药物预防为主。本文主要就术后谵妄的分型、危险因素、发病机制及药物治疗作一综述,以期为临床治疗提供参考。
Abstract:
Delirium is an acute and fluctuating disease. It is mainly characterized by increased excitability, manifested as thinking disorder, disorientation, inattention, diurnal reversal, and changes in consciousness. It can lead to increased postoperative complications. Increasing perioperative mortality, but the current research on the pathogenesis of postoperative delirium is still controversial, and its treatment is still mainly based on drug prevention. This article mainly reviews the classification, risk factors, pathogenesis and drug treatment of postoperative delirium, in order to provide reference for clinical treatment.

参考文献/References:

[1]Marcantonio ER.Delirium in Hospitalized Older Adults[J].N Engl J Med,2017,377(15):1456-1466.[2]Marcantonio ER.Postoperative delirium:a 76-year-old woman with delirium following surgery[J].JAMA,2012,308(1):73-81.[3]Lingehall HC,Smulter NS,Lindahl E,et al.Preoperative Cognitive Performance and Postoperative Delirium Are Independently Associated With Future Dementia in Older People Who Have Undergone Cardiac Surgery:A Longitudinal Cohort Study[J].Crit Care Med,2017,45(8):1295-1303.[4]Adamis D,Meagher D,Williams J,et al.A systematic review and meta-analysis of the association between the apolipoprotein E genotype and delirium[J].Psychiatr Genet,2016,26(2):53-59. [5]van der Sluis FJ,Buisman PL,Meerdink M,et al.Risk factors for postoperative delirium after colorectal operation[J].Surgery,2017,161(3):704-711.[6]王玉田,周升柱,王泽平,等.麻醉相关的术后谵妄影响因素分析[J].中国实验诊断学,2015(5):865-868.[7]Wyrobek J,LaFlam A,Max L,et al.Association of intraoperative changes in brain-derived neurotrophic factor and postoperative delirium in older adults[J].Br J Anaesth,2017,119(2):324-332.[8]Zenilman ME.Delirium:An Important Postoperative Complication[J].JAMA,2017,317(1):77-78.[9]Lee H,Oh SY,Yu JH,et al.Risk Factors of Postoperative Delirium in the Intensive Care Unit After Liver Transplantation[J].World J Surg,2018,42(9):2992-2999. [10]González M,Martínez G,Calderón J,et al.Impact of delirium on short-term mortality in elderly inpatients:a prospective cohort study[J].Psychosomatics,2009,50(3):234-238.[11]Hshieh TT,Saczynski J,Gou RY,et al.Trajectory of Functional Recovery After Postoperative Delirium in Elective Surgery[J].Ann Surg,2017,265(4):647-653.[12]Adamis D,Van Munster BC,Macdonald AJ.The genetics of deliria[J].Int Rev Psychiatry,2009,21(1):20-29.[13]Girard TD,Exline MC,Carson SS,et al.Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness[J].N Engl J Med,2018,379(26):2506-2516.[14]van Gool WA.D van de Beek.and P.Eikelenboom.Systemic infection and delirium: when cytokines and acetylcholine collide[J].Lancet,2010,375(9716):773-775.[15]Sun L,Jia P,Zhang J,et al.Production of inflammatory cytokines,cortisol,and Aβ1-40 in elderly oral cancer patients with postoperative delirium[J].Neuropsychiatr Dis Treat,2016(12):2789-2795.[16]Cape E,Hall RJ,van Munster BC,et al.Cerebrospinal fluid markers of neuroinflammation in delirium:a role for interleukin-1β in delirium after hip fracture[J].J Psychosom Res,2014,77(3):219-225.[17]Umholtz M,Nader ND.Anesthetic Immunomodulation of the Neuroinflammation in Postoperative Cognitive Dysfunction[J].Immunol Invest,2017,46(8):805-815.[18]Dillon ST,Vasunilashorn SM,Ngo L,et al.Higher C-Reactive Protein Levels Predict Postoperative Delirium in Older Patients Undergoing Major Elective Surgery:A Longitudinal Nested Case-Control Study[J].Biol Psychiatry,2017,81(2):145-153.[19]Cerejeira J,Batista P,Nogueira V,et al.The stress response to surgery and postoperative delirium: evidence of hypothalamic-pituitary-adrenal axis hyperresponsiveness and decreased suppression of the GH/IGF-1 Axis[J].J Geriatr Psychiatry Neurol,2013,26(3):185-194.[20]Gunther ML,Morandi A,Krauskopf E,et al.The association between brain volumes,delirium duration,and cognitive outcomes in intensive care unit survivors:the VISIONS cohort magnetic resonance imaging study[J].Crit Care Med,2012,40(7):2022-2032.[21]Morandi A,Rogers BP,Gunther ML,et al.The relationship between delirium duration,white matter integrity,and cognitive impairment in intensive care unit survivors as determined by diffusion tensor imaging:the VISIONS prospective cohort magnetic resonance imaging study[J].Crit Care Med,2012,40(7):2182-2189. [22]Angeles-Castellanos M,Ramírez-Gonzalez F,Ubaldo-Reyes L,et al.Loss of melatonin daily rhythmicity is asociated with delirium development in hospitalized older adults[J].Sleep Sci,2016,9(4):285-288.[23]Wei P,Liu N,Zhang Z,et al.Processing of visually evoked innate fear by a non-canonical thalamic pathway[J].Nat Commun,2015(6):6756. [24]Fukata S,Kawabata Y,Fujisiro K,et al.Haloperidol prophylaxis does not prevent postoperative delirium in elderly patients:a randomized,open-label prospective trial[J].Surg Today,2014,44(12):2305-2313. [25]Fukata S,Kawabata Y,Fujishiro K,et al.Haloperidol prophylaxis for preventing aggravation of postoperative delirium in elderly patients:a randomized,open-label prospective trial[J].Surg Today,2017,47(7):815-826. [26]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.[27]Reade MC,Eastwood GM,Bellomo R,et al.Effect of Dexmedetomidine Added to Standard Care on Ventilator-Free Time in Patients With Agitated Delirium:A Randomized Clinical Trial[J].JAMA,2016,315(14):1460-1468.[28]Djaiani G,Silverton N,Fedorko L,et al.Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac Surgery:A Randomized Controlled Trial[J].Anesthesiology,2016,124(2):362-368.[29]Deiner S,Luo X,Lin HM,et al.Intraoperative Infusion of Dexmedetomidine for Prevention of Postoperative Delirium and Cognitive Dysfunction in Elderly Patients Undergoing Major Elective Noncardiac Surgery:A Randomized Clinical Trial[J].JAMA Surg,2017,152(8):e171505.[30]Hudetz JA,Patterson KM,Iqbal Z,et al.Ketamine attenuates delirium after cardiac surgery with cardiopulmonary bypass[J].J Cardiothorac Vasc Anesth,2009,23(5):651-657.[31]Avidan MS,Maybrier HR,Abdallah AB,et al.Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults: an international, multicentre,double-blind,randomised clinical trial[J].Lancet,2017,390(10091):267-275.[32]Leung JM,Sands LP,Rico M,et al.Pilot clinical trial of gabapentin to decrease postoperative delirium in older patients[J].Neurology,2006,67(7):1251-1253.[33]Leung JM,Sands LP,Chen N,et al.Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients:A Randomized Clinical Trial[J].Anesthesiology,2017,127(4):633-644.[34]Royse CF,Saager L,Whitlock R,et al.Impact of Methylprednisolone on Postoperative Quality of Recovery and Delirium in the Steroids in Cardiac Surgery Trial:A Randomized,Double-blind,Placebo-controlled Substudy[J].Anesthesiology,2017,126(2):223-233.

相似文献/References:

[1]刘 璐,秦新月.阿尔茨海默病患者血尿酸水平变化的研究[J].医学信息,2018,31(02):96.[doi:10.3969/j.issn.1006-1959.2018.02.033]
 LIU Lu,QIN Xin-yue.Study on the Changes of Serum Uric Acid in Alzheimer 's Disease Patients[J].Medical Information,2018,31(22):96.[doi:10.3969/j.issn.1006-1959.2018.02.033]
[2]王玉霞.剖宫产术后子宫疤痕妊娠的临床诊治[J].医学信息,2018,31(10):48.[doi:10.3969/j.issn.1006-1959.2018.10.015]
 WANG Yu-xia.Clinical Diagnosis and Treatment of Uterine Scar Pregnancy after Cesarean Section[J].Medical Information,2018,31(22):48.[doi:10.3969/j.issn.1006-1959.2018.10.015]
[3]刘革铭,马洪俊,刘 毅,等.心力衰竭的机制及诊疗的研究[J].医学信息,2022,35(10):91.[doi:10.3969/j.issn.1006-1959.2022.10.022]
 LIU Ge-ming,MA Hong-jun,LIU Yi,et al.Mechanism, Diagnosis and Treatment of Heart Failure[J].Medical Information,2022,35(22):91.[doi:10.3969/j.issn.1006-1959.2022.10.022]
[4]只茂叶.重症急性胰腺炎的发病机制与内镜治疗研究[J].医学信息,2022,35(11):68.[doi:10.3969/j.issn.1006-1959.2022.11.019]
 ZHI Mao-ye.The Pathogenesis and Endoscopic Treatment of Severe Acute Pancreatitis[J].Medical Information,2022,35(22):68.[doi:10.3969/j.issn.1006-1959.2022.11.019]
[5]王煜婷.原发性痛经发病机制及口服药物治疗进展[J].医学信息,2018,31(13):56.[doi:10.3969/j.issn.1006-1959.2018.13.016]
 WANG Yu-ting.Research Progress in Pathogenesis and Oral Medication of Primary Dysmenorrhea[J].Medical Information,2018,31(22):56.[doi:10.3969/j.issn.1006-1959.2018.13.016]
[6]郑小鹏,辛 华.糖尿病肾病研究进展[J].医学信息,2018,31(16):26.[doi:10.3969/j.issn.1006-1959.2018.16.008]
 ZHENG Xiao-peng,XIN Hua.Progress in the Study of Diabetic Nephropathy[J].Medical Information,2018,31(22):26.[doi:10.3969/j.issn.1006-1959.2018.16.008]
[7]孟 强,孙 杨,刘 永.术后谵妄病理生理机制的研究现状[J].医学信息,2018,31(19):54.[doi:10.3969/j.issn.1006-1959.2018.19.018]
 MENG Qiang,SUN Yang,LIU Yong.Current Status of Research on Pathophysiological Mechanism of Postoperative Delirium[J].Medical Information,2018,31(22):54.[doi:10.3969/j.issn.1006-1959.2018.19.018]
[8]马宏境,刘 彬.慢性阻塞性肺疾病发病机制的研究[J].医学信息,2019,32(10):50.[doi:10.3969/j.issn.1006-1959.2019.10.018]
 MA Hong-jing,LIU Bin.Study on the Pathogenesis of Chronic Obstructive Pulmonary Disease[J].Medical Information,2019,32(22):50.[doi:10.3969/j.issn.1006-1959.2019.10.018]
[9]国欣涛,魏荣伟,王 斌.冠状动脉搭桥术后谵妄的研究现状[J].医学信息,2019,32(10):53.[doi:10.3969/j.issn.1006-1959.2019.10.019]
 GUO Xin-tao,WEI Rong-wei,WANG Bin.Current Status of Research on Postoperative Delirium Coronary Artery Bypass Grafting[J].Medical Information,2019,32(22):53.[doi:10.3969/j.issn.1006-1959.2019.10.019]
[10]邵永康.维持性血液透析患者并发症的发病机制分析[J].医学信息,2019,32(17):35.[doi:10.3969/j.issn.1006-1959.2019.17.012]
 SHAO Yong-kang.Pathogenesis Analysis of Complications in Maintenance Hemodialysis Patients[J].Medical Information,2019,32(22):35.[doi:10.3969/j.issn.1006-1959.2019.17.012]

更新日期/Last Update: 1900-01-01