《（优质医学）ICU谵妄及ABCDE集束化预防方案》由会员分享，可在线阅读，更多相关《（优质医学）ICU谵妄及ABCDE集束化预防方案（85页珍藏版）》请在金锄头文库上搜索。
1、Delirium -谵妄,1,内容,谵妄的流行病学 谵妄概念、主要特征和分类 谵妄的目前关注情况 谵妄的危害 谵妄的风险因素 谵妄评估及诊断 谵妄的预防 谵妄预防的集束化方案-ABCDE方案 谵妄治疗,2,流行病学,Delirium occurs in up to 80% of patients admitted to intensive care units. Although under-diagnosed, delirium is associated with a significant increase in morbidity and mortality in critical p
2、atients. ICU患者谵妄发生率接近80% 尽管谵妄诊断不足，谵妄与明显增加危重患者发病率和病死率相关,3,流行病学,Delirium is common in the ICU, affecting 60% to 80% of mechanically ventilated patients and 20% to 50% of nonmechanically ventilated patients 谵妄在ICU很常见 60-80%机械通气患者发生谵妄 20-50%非机械通气患者发生谵妄,4,内容,谵妄的流行病学 谵妄概念、主要特征和分类 谵妄的目前关注情况 谵妄的危害 谵妄的风险因素 谵
3、妄评估及诊断 谵妄的预防 谵妄预防的集束化方案-ABCDE方案 谵妄治疗,5,概念,Delirium in the intensive care unit (ICU) represents an acute form of organ dysfunction,which manifests as a rapidly developing disturbance of both consciousness and cognition that tends to fluctuate throughout the course of a day 谵妄以急性器官功能障碍为表现形式：倾向于1天内波动性的
4、、迅速发展的意识和认知紊乱。,6,谵妄的主要特征,The American Psychiatric Association (APA)Diagnostic and Statistical Manual of Mental Disorders,fourth edition, text revision (DSM-IV) defines 4 key features of delirium: (1) disturbance of consciousness with reduced awareness of the environment and impaired ability to focus
5、, sustain, or shift attention; (2) altered cognition (eg, impaired memory, language disturbance, or disorientation) or the development of a perceptual（知觉） disturbance (eg, hallucinations（幻觉）, delusions（妄想）, or illusions（错觉）) that is not better accounted for by preexisting or evolving dementia（痴呆）;,7
6、,谵妄的主要特征,(3) disturbance that develops over a short period of time (hours to days) and tends to fluctuate during the course of the day; (4) evidence of an etiologic factor (ie, delirium due to general medical condition, substance-induced delirium, delirium due to multiple causes, or delirium not oth
7、erwise specified),8,谵妄分类-发病时间,The classification of delirium can be subdivided by course over time and motor subtypes. 1.The terminology, according to the course over time, includes a) prevalent (if it is detected at the time of admission); b) incident (if it emerges during the hospital length of st
8、ay); and c) persistent (if the symptoms persist over time),9,谵妄分类-运动亚型,2.The terminology according to motor subtypes includes a) hyperactive delirium (in which there is an increase in the psychomotor activity and agitation, with attempts to remove invasive devices); b) hypoactive delirium (character
9、ized by psychomotor slowing, apathy(淡漠), lethargy（昏睡） and a decrease in response to external stimuli); and c) mixed delirium (with unpredictable fluctuation of symptoms between the first two subtypes),10,谵妄分类,3.Additional definitions are described, which include subsyndromal delirium （亚临床谵妄）and deli
10、rium superimposed on dementia（谵妄叠加痴呆）,11,谵妄分类-根据ICDSC评分工具,4.defined its presence, using the Intensive Care Delirium Screening Checklist(ICDSC), in a population from an ICU. The ICDSC assigns a score from 0 to 8 points, delirium : a score 4 subsyndromal delirium: a score between 1 and 3,12,内容,谵妄的流行病学
11、 谵妄概念、主要特征和分类 谵妄的目前关注情况 谵妄的危害 谵妄的风险因素 谵妄评估及诊断 谵妄的预防 谵妄预防的集束化方案-ABCDE方案 谵妄治疗,13,目前ICU谵妄关注情况,14,镇静和谵妄评估现状,15,使用现有谵妄评估方法的频率,16,ICU谵妄评估的障碍,17,护理人员对谵妄评估的看法,18,内容,谵妄的流行病学 谵妄概念、主要特征和分类 谵妄的目前关注情况 谵妄的危害 谵妄的风险因素 谵妄评估及诊断 谵妄的预防 谵妄预防的集束化方案-ABCDE方案 谵妄治疗,19,谵妄的危害,increased risk for prolonged mechanical ventilation
12、, catheter removal,self-extubation, and the need for physical restraints. In addition, delirium predisposes patients（有谵妄倾向患者） to longer hospital stays, with greater health care costs, increased risk of death during the hospitalization, and increased odds of institutionalization following discharge.
13、Even after hospital discharge, the amount of time a patient has been delirious in the ICU predicts long-term cognitive impairment, physical disability, and death up to a year later.,20,21,22,23,24,25,26,内容,谵妄的流行病学 谵妄概念、主要特征和分类 谵妄的目前关注情况 谵妄的危害 谵妄的风险因素 谵妄评估及诊断 谵妄的预防 谵妄预防的集束化方案-ABCDE方案 谵妄治疗,27,ICU谵妄的风险
14、因素,The average medical ICU patient has 11 or more risk factors for developing delirium, 11which can be divided into baseline (predisposing) and hospital-related (precipitating) factors,28,29,30,内容,谵妄的流行病学 谵妄概念、主要特征和分类 谵妄的目前关注情况 谵妄的危害 谵妄的风险因素 谵妄评估及诊断 谵妄的预防 谵妄预防的集束化方案-ABCDE方案 谵妄治疗,31,谵妄评估,ICU理想的谵妄评估工具
15、 the scale used in this environment must a) have the capacity to evaluate the primary components of delirium (for example, awareness, inattention, disorganized thought and fluctuation course); b) must have proven validity and reliability in ICU populations; c) must involve a fast and easy evaluation
16、; and d) should not necessitate the presence of psychiatric professionals,32,ICU谵妄评估工具,1.the Confusion Assessment Method-ICU (CAM-ICU) 把RASS评分整合到CAM-ICU确定有效的两个版本：葡萄糖牙版本和英国版本 2.the Intensive Care Delirium Screening Checklist(ICDSC),33,CAM-ICU,34,ICU谵妄诊断,DSM-是目前谵妄最主要的诊断标准，较专业且繁琐 意识模糊评定法（CAM法）：包括4个方面 1.急性起病，病程波动 2.注意力障碍 3.思维混乱 4.意识清晰水平改变：清晰（阴性)、警惕、嗜睡、昏睡、昏迷 诊断：1和2存在，加上3或者4的任意一条即为CAM(+),表示谵妄存在。敏感性86%，特异性100%。,35,葡萄牙版本of CAM-ICU,36,English versi
