一例苏醒期谵妄引发的思考( 三 ) _健康小知识

然而，不推荐预防性使用氟哌啶醇来预防谵妄。 Beers标准将抗精神病药列为老年人应避免使用的药物。一项多中心研究将70岁以上的内科和外科患者随机分至氟哌啶醇或安慰剂，这些患者均还接受预防谵妄的非药物策略[30] 。谵妄发生率、持续时间或严重程度都没有差异。同样，其他抗精神病药(典型或非典型)没有改变普通内科或术后危重症患者的谵妄发生率、持续时间或严重程度，而且可能带来危害[31-33] 。
如果谵妄严重且持续存在，则需请神经科会诊，急性颅内事件(如脑卒中)是其罕见原因。持续数小时或数日的谵妄与以下方面有关：年龄较大、术前认知功能障碍、饮酒、严重躯体疾病和特定的实验室检查异常(如钠或葡萄糖水平)[34-39] 。出PACU时谵妄提示术后晚期的持续性谵妄，患者的结局比无此并发症的患者更差，例如死亡、住院时间延长、出院后转入其他照护机构[40] 。
作者：张子银广州中医药大学第一附属医院
参考文献
1.BrownEN,LydicR,SchiffND.Generalanesthesia,sleep,andcoma.NEnglJMed2010;363:2638.
2.ZelcerJ,WellsDG.Anaesthetic-relatedrecoveryroomcomplications.AnaesthIntensiveCare1987;15:168.
3.FrostEA.Differentialdiagnosisofdelayedawakeningfromgeneralanesthesia:areview.MiddleEastJAnaesthesiol2014;22:537.
4PavlinDJ,RappSE,PolissarNL,etal.Factorsaffectingdischargetimeinadultoutpatients.AnesthAnalg1998;87:816.
5.EngbersF.Isunconsciousnesssimplythereverseofconsciousness?Anaesthesia2018;73:6.
6.PanditJJ.Monitoring(un)consciousness:theimplicationsofanewdefinitionof'anaesthesia'.Anaesthesia2014;69:801.
7.JungYS,PaikH,MinSH,etal.Callingthepatient'sownnamefacilitatesrecoveryfromgeneralanaesthesia:arandomiseddouble-blindtrial.Anaesthesia2017;72:197.
8.HewerCL.THESTAGESANDSIGNSOFGENERALANAESTHESIA.BrMedJ1937;2:274.
9.CardE,PandharipandeP,TomesC,etal.Emergencefromgeneralanaesthesiaandevolutionofdeliriumsignsinthepost-anaesthesiacareunit.BrJAnaesth2015;115:411.
10.GuentherU,RiedelL,RadtkeFM.Patientsproneforpostoperativedelirium:preoperativeassessment,perioperativeprophylaxis,postoperativetreatment.CurrOpinAnaesthesiol2016;29:384.
11.MunkL,AndersenG,M?llerAM.Post-anaestheticemergencedeliriuminadults:incidence,predictorsandconsequences.ActaAnaesthesiolScand2016;60:1059.
12.HewerCL.THESTAGESANDSIGNSOFGENERALANAESTHESIA.BrMedJ1937;2:274.
13.CardE,PandharipandeP,TomesC,etal.Emergencefromgeneralanaesthesiaandevolutionofdeliriumsignsinthepost-anaesthesiacareunit.BrJAnaesth2015;115:411.
14.GuentherU,RiedelL,RadtkeFM.Patientsproneforpostoperativedelirium:preoperativeassessment,perioperativeprophylaxis,postoperativetreatment.CurrOpinAnaesthesiol2016;29:384.
15.MunkL,AndersenG,M?llerAM.Post-anaestheticemergencedeliriuminadults:incidence,predictorsandconsequences.ActaAnaesthesiolScand2016;60:1059.
16.CarvalhoDZ,TownleyRA,BurkleCM,etal.PropofolFrenzy:ClinicalSpectrumin3Patients.MayoClinProc2017;92:1682.
17.CardE,PandharipandeP,TomesC,etal.Emergencefromgeneralanaesthesiaandevolutionofdeliriumsignsinthepost-anaesthesiacareunit.BrJAnaesth2015;115:411.
18.LawlorPG,GagnonB,ManciniIL,etal.Occurrence,causes,andoutcomeofdeliriuminpatientswithadvancedcancer:aprospectivestudy.ArchInternMed2000;160:786.
19.AouadMT,ZeeniC,AlNawwarR,etal.DexmedetomidineforImprovedQualityofEmergenceFromGeneralAnesthesia:ADose-FindingStudy.AnesthAnalg2017.
20.KimSY,KimJM,LeeJH,etal.Efficacyofintraoperativedexmedetomidineinfusiononemergenceagitationandqualityofrecoveryafternasalsurgery.BrJAnaesth2013;111:222.
21.KimDJ,KimSH,SoKY,JungKT.Effectsofdexmedetomidineonsmoothemergencefromanaesthesiainelderlypatientsundergoingorthopaedicsurgery.BMCAnesthesiol2015;15:139.
22.DuanX,CoburnM,RossaintR,etal.Efficacyofperioperativedexmedetomidineonpostoperativedelirium:systematicreviewandmeta-analysiswithtrialsequentialanalysisofrandomisedcontrolledtrials.BrJAnaesth2018;121:384.