ICU谵妄和ABCDE集束化预防方案.ppt
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- ICU 谵妄 ABCDE 集束 预防 方案
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1、南华大学附属第一医院ICU 王桥生Delirium-谵妄内容r谵妄的流行病学r谵妄概念、主要特征和分类r谵妄的目前关注情况r谵妄的危害r谵妄的风险因素r谵妄评估及诊断r谵妄的预防r谵妄预防的集束化方案-ABCDE方案r谵妄治疗流行病学rDelirium 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 cri
2、tical patients.rICU患者谵妄发生率接近80%r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流行病学rDelirium is common in the ICU,affecting 60%to 80%of mechanically ventilated patients and 20%to 50%of nonmechanically ventilated patientsr谵妄在ICU很常见r60-80%机械通气患者发生谵妄r20-50%非机械通气患者发生谵妄内容r谵妄的流行病学r谵妄概念、主要特征和分类r谵妄的目前关注情况r谵妄的危害r谵妄的风险因素r谵妄评估及
3、诊断r谵妄的预防r谵妄预防的集束化方案-ABCDE方案r谵妄治疗概念rDelirium 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 dayr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、迅速发展的意识和
4、认知紊乱。谵妄的主要特征rThe American Psychiatric Association(APA)Diagnostic and Statistical Manual of Mental Disorders,fourth edition,text revision(DSM-IV)defines 4 key features of delirium:r(1)disturbance of consciousness with reduced awareness of the environment and impaired ability to focus,sustain,or shift
5、 attention;r(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);谵妄的主要特征r(3)disturbance that devel
6、ops over a short period of time(hours to days)and tends to fluctuate during the course of the day;r(4)evidence of an etiologic factor(ie,delirium due to general medical condition,substance-induced delirium,delirium due to multiple causes,or delirium not otherwise specified)谵妄分类-发病时间rThe classificati
7、on of delirium can be subdivided by course over time and motor subtypes.r1.The terminology,according to the course over time,includesra)prevalent(if it is detected at the time of admission);rb)incident(if it emerges during the hospital length of stay);rand c)persistent(if the symptoms persist over t
8、ime)谵妄分类-运动亚型r2.The terminology according to motor subtypes includesr a)hyperactive delirium(in which there is an increase in the psychomotor activity and agitation,with attempts to remove invasive devices);rb)hypoactive delirium(characterized by psychomotor slowing,apathy(淡漠),lethargy(昏睡)and a decr
9、ease in response to external stimuli);rand c)mixed delirium(with unpredictable fluctuation of symptoms between the first two subtypes)谵妄分类r3.Additional definitions are described,which include rsubsyndromal delirium(亚临床谵妄)and rdelirium superimposed on dementia(谵妄叠加痴呆)谵妄分类-根据ICDSC评分工具r4.defined its pr
10、esence,using the Intensive Care Delirium Screening Checklist(ICDSC),in a population from an ICU.The ICDSC assigns a score from 0 to 8 points,rdelirium:a score 4 rsubsyndromal delirium:a score between 1 and 3 内容r谵妄的流行病学r谵妄概念、主要特征和分类r谵妄的目前关注情况r谵妄的危害r谵妄的风险因素r谵妄评估及诊断r谵妄的预防r谵妄预防的集束化方案-ABCDE方案r谵妄治疗目前ICU谵妄
11、关注情况镇静和谵妄评估现状使用现有谵妄评估方法的频率ICU谵妄评估的障碍护理人员对谵妄评估的看法内容r谵妄的流行病学r谵妄概念、主要特征和分类r谵妄的目前关注情况r谵妄的危害r谵妄的风险因素r谵妄评估及诊断r谵妄的预防r谵妄预防的集束化方案-ABCDE方案r谵妄治疗谵妄的危害rincreased risk for prolonged mechanical ventilation,catheter removal,self-extubation,and the need for physical restraints.rIn addition,delirium predisposes patie
12、nts(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.rEven after hospital discharge,the amount of time a patient has been delirious in the ICU predicts long-term cognitive
13、 impairment,physical disability,and death up to a year later.内容r谵妄的流行病学r谵妄概念、主要特征和分类r谵妄的目前关注情况r谵妄的危害r谵妄的风险因素r谵妄评估及诊断r谵妄的预防r谵妄预防的集束化方案-ABCDE方案r谵妄治疗ICU谵妄的风险因素rThe average medical ICU patient has 11 or more risk factors for developing delirium,r11which can be divided into baseline(predisposing)and hosp
14、ital-related(precipitating)factors内容r谵妄的流行病学r谵妄概念、主要特征和分类r谵妄的目前关注情况r谵妄的危害r谵妄的风险因素r谵妄评估及诊断r谵妄的预防r谵妄预防的集束化方案-ABCDE方案r谵妄治疗谵妄评估rICU理想的谵妄评估工具r the scale used in this environment must ra)have the capacity to evaluate the primary components of delirium(for example,awareness,inattention,disorganized thought
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