酒精戒断所致震颤谵妄与非震颤谵妄患者DNA 氧化损伤的比较

目的 DNA氧化损伤标记物8-羟基脱氧鸟苷(8-OHd G)与酒精戒断有密切联系,本研究通过对酒精戒断所致震颤谵妄与非震颤谵妄患者DNA氧化损伤的比较,为临床早发现早治疗提供理论依据。方法将176例慢性酒精中毒患者按入院后是否出现震颤谵妄分为震颤谵妄组及非震颤谵妄组,采用酶联免疫吸附法(ELISA)检测血清8-OHd G水平,采用酒精戒断状态评定量表(CIWA-Ar)评定两组戒断严重程度。结果震颤谵妄组8-OHd G水平高于非震颤谵妄组,差异有统计学意义[(0.58±0.12)ng/ml vs.(0.35±0.13)ng/ml,P0.01];8-OHd G水平与酒精戒断状态评定量表CIWA-Ar评分呈正相关(r=0.84);逐步Logistic回归分析显示8-OHd G(OR=6.3)是震颤谵妄的独立危险因素。结论检测外周血8-OHd G水平可能有助于酒精戒断所致震颤谵妄的早期诊断及病情判定。     

基于引文聚类技术的谵妄护理研究热点探析

目的 探索谵妄护理研究的发展趋势,明确研究热点,确定我国谵妄护理下一步的研究方向和重点。方法 以MeSH词表中“Delirium nursing”为主题词,获取 Web of Science 核心合集中1990年至2020年谵妄护理的相关文献,将文献按发表时间分为1990-2000年、2001-2010年和2011-2020年三个阶段,分阶段进行文献计量及聚类分析。结果 在Web of Science核心合集中获取1634篇相关文献,发文量排名前3位的国家是美国、澳大利亚、加拿大,相关研究内容较多元，以每10年为一个节点，分别深入分析近30年谵妄护理相关研究的主题，共得到47个聚类，24个重要的高频关键词 。结论 谵妄护理研究历经高危患者的谵妄诊断和护理、谵妄评估方法的开发和应用,随着研究的深入和推移,谵妄危险因素的评估、预防策略制定和实施是当前谵妄护理研究的热点。     

降钙素原水平对ICU患者发生谵妄的影响及临床意义

[目的]评估降钙素原水平对重症医学科(ICU)患者发生谵妄的影响及临床意义.[方法]选取本院ICU 2016年1月30日至2018年12月30日收治的90例住院患者,根据ICU意识模糊评估量表(CAM-ICU)将患者分为发生谵妄患者(CAM-ICU阳性)和未发生谵妄患者(CAM-ICU阴性),检测患者外周血中降钙素原水平,观察患者相关血清学指标及临床资料与谵妄的相关性,并采用多因素分析评估谵妄发生的影响因素.使用受试者工作特征曲线(ROC)分析降钙素原水平对ICU患者发生谵妄的预测作用.[结果]90例患者中,共发生谵妄40例(44.4%).降钙素原水平<0.5μg/L 23例,降钙素原水平为0.5~2μg/L 41例,降钙素原水平>2μg/L 26例.发生谵妄患者与未发生谵妄患者合并糖尿病比例、血降钙素原水平、C-反应蛋白、乳酸水平相比较差异均有显著性(P<0.05).多因素分析结果显示,血降钙素原水平(95%CI:1.298~5.591)、C-反应蛋白(95%CI:1.093~4.789)、乳酸水平(95%CI:1.154~5.247)是ICU住院患者谵妄的独立影响因素(P<0.05).血降钙素原水平预测ICU住院患者谵妄的最佳临界点为52.1.当血降钙素原水平为52.1时,血降钙素原水平预测ICU住院患者谵妄的灵敏度为72.2%,特异度为82.4%;AUC曲线下面积为0.82.[结论]血降钙素原水平升高的ICU住院患者更易发生谵妄,血降钙素原水平是预测ICU住院患者谵妄的有效生物学指标.     

Ultra-brief Screeners for Detecting Delirium Superimposed on Dementia

ObjectiveDelirium superimposed on dementia (DSD) is common, morbid, and costly, yet frequently undiagnosed. Our study aimed to develop a brief screening test to improve health care worker recognition of DSD.Design/Setting/ParticipantsOlder hospitalized adults with dementia were prospectively enrolled from medical and surgical inpatient units of 3 hospitals (2 in Pennsylvania, 1 in Tennessee).MeasuresThe reference standard delirium assessment used Confusion Assessment Method (CAM) criteria and was based on a structured interview including the Mini-Mental State Examination, interviewer observations, and medical record review. To develop the screening test, 1-, 2-, and 3-item combinations from the reference standard assessment were analyzed to determine their sensitivity and specificity in diagnosing delirium presence in a dementia population compared to the reference standard. For multiple-item screeners, error on 1 or more items was considered a positive screen.ResultsOverall, 391 older adults with dementia were enrolled (mean age: 83.9 years, 71.1% female), and 95 (24.4%) developed DSD during their hospitalization, based on the reference standard. The best single-item screen for DSD was “What day of the week is it?” with 84% sensitivity [95% confidence interval (CI): 0.75, 0.91] and 41% specificity (CI: 0.35, 0.47). The best 2-item screen was “list the days of the week backwards” and “What day of the week is it?” with 93% sensitivity (CI: 0.85, 0.97) and 30% specificity (CI: 0.25, 0.36). The best 3-item screen was “list the days of the week backwards,” “What type of place is this? [hospital]” and “Does the patient appear sleepy?” with 94% sensitivity (CI: 0.87, 0.98) and 42% specificity (CI: 0.36, 0.48).Conclusions/ImplicationsWe identified a 3-item DSD screener with excellent sensitivity but limited specificity. This screener can be used to quickly rule out DSD in populations with a high prevalence of dementia and is a promising step toward developing efficient tools for DSD recognition among care providers.     

术后认知功能障碍临床相关因素的研究进展

术后认知功能障碍是一种常见并且严重的术后合并症.老年人术后发生认知障碍的情况并不少见.有多种因素可能与其发生有关,包括年龄、术前合并疾病、精神状态、用药、围术期管理等.术后认知障碍的研究有助于人们认识围术期可能造成认知损害的多种因素,以便临床医生针对相关因素进行综合防治.     

Cytokines and acute phase response in delirium

OBJECTIVE: This study aimed to examine the expression patterns of pro- and anti-inflammatory cytokines in elderly patients with and without delirium who were acutely admitted to the hospital. METHODS: All consecutive patients aged 65 years and older, who were acutely admitted to the Department of Internal Medicine of the Academic Medical Center, Amsterdam, a tertiary university teaching hospital, were invited. Members of the geriatric consultation team completed a multidisciplinary evaluation for all study participants within 48 h after admission, including cognitive and functional examination by validated measures of delirium, memory, and executive function. C-reactive protein and cytokines (IL-1beta, IL-6, TNF-alpha, IL-8, and IL-10) were determined within 3 days after admission. RESULTS: In total, 185 patients were included; mean age was 79 years; 42% were male; and 34.6% developed delirium within 48 h after admission. Compared to patients without delirium, patients with delirium were older and had experienced preexistent cognitive impairment more often. In patients with delirium, significantly more IL-6 levels (53% vs. 31%) and IL-8 levels (45% vs. 22%) were above the detection limit as compared with patients who did not have delirium. After adjusting for infection, age, and cognitive impairment, these differences were still significant. CONCLUSIONS: Proinflammatory cytokines may contribute to the pathogenesis of delirium in acutely admitted elderly patients.     

Safety profile of Tysabri: international risk management plan

An 83-year-old man was admitted for right lower lobe pneumonia which did not improve after a 5-day outpatient treatment with amoxicillin/clavulinate and clarithromycin. An empiric treatment with levofloxacin was started with a significant improvement after 24 h of this treatment. On the third day of hospitalization, delirium developed, while the patient was afebrile and with normal blood oxygenation. Treatment with levofloxacin was stopped, and a complete resolution of the patient’s delirium was observed 2 days later. To the best of our knowledge, this is the third case of levofloxacin-induced delirium described in the medical literature.     

Implementation,reliability testing,and compliance monitoring of the Confusion Assessment Method for the Intensive Care Unit in trauma patients

OBJECTIVE: To implement delirium monitoring, test reliability, and monitor compliance of performing the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) in trauma patients. DESIGN AND SETTING: Prospective, observational study in a level 1 trauma unit of a tertiary care, university-based medical center. PATIENTS: Acutely injured patients admitted to the trauma unit between 1 February 2006 and 16 April 2006. MEASUREMENTS AND RESULTS: Following web-based teaching modules and group in-services, bedside nurses evaluated patients daily for depth of sedation with the Richmond Agitation-Sedation Scale (RASS) and for the presence of delirium with the CAM-ICU. On randomly assigned days over a 10-week period, evaluations by nursing staff were followed by evaluations by an expert evaluator of the RASS and the CAM-ICU to assess compliance and reliability of the CAM-ICU in trauma patients. Following the audit period the nurses completed a postimplementation survey. The expert evaluator performed 1,011 random CAM-ICU assessments within 1[Symbol: see text]h of the bedside nurse's assessments. Nurses completed the CAM-ICU assessments in 84% of evaluations. Overall agreement (kappa) between nurses and expert evaluator was 0.77 (0.721-0.822; p[Symbol: see text]<[Symbol: see text]0.0001), in TBI patients 0.75 (0.667-0.829; p[Symbol: see text]<[Symbol: see text]0.0001) and in mechanically ventilated patients 0.62 (0.534-0.704; p[Symbol: see text]<[Symbol: see text]0.0001). The survey revealed that nurses were confident in performing the CAM-ICU, realized the importance of delirium, and were satisfied with the training that they received. It also acknowledged obstacles to implementation including nursing time and failure of physicians/surgeons to address treatment approaches for delirium. CONCLUSIONS: The CAM-ICU can be successfully implemented in a university-based trauma unit with high compliance and reliability. Quality improvement projects seeking to implement delirium monitoring would be wise to address potential pitfalls including time complaints and the negative impact of physician indifference regarding this form of organ dysfunction.