老年单侧髋关节置换术后谵妄非药物性预防的研究进展
|
张媛
|
南通大学附属医院如皋分院 老年医学科，江苏如皋，226500
|
摘要：目的 系统性综述老年单侧髋关节置换术后谵妄非药物性预防策略的研究现状并探讨由循证证据到临床应用转化的过程。方法 本文从国内外的相关文献出发，进行了系统的整理和综合性的分析。内容包括多因素病因模型的术后谵妄、围术期( 术前、术中、术后) 不同时间段内非药物干预策略及其证据支持等内容。并且用实施科学理论探讨了实际操作过程中遇到的问题以及未来的发展趋势等。结果 现有的研究发现，术后谵妄是易感因素和诸多诱发因素共同作用导致的，非药物性预防措施是一个持续性的工作，并且贯穿整个围术期阶段，其包含术前对存在高风险的病人开展预评估与康复治疗，手术当中优化麻醉管理，在手术之后采取以老年医院生活计划（HELP）为代表多种模式联合集束化处理方案（包含镇痛）、早期行动、睡眠诱导、认知导向等内容。目前该领域的主要挑战已经由缺乏有效的证据变成了证据难以转化为实际应用。结论 老年髋关节置换术后的谵妄预防要由被动药物治疗转为主动的、多学科合作非药物干预的新模式。未来的主要工作就是采取科学方法，促进临床文化改变，把保持病人大脑健康放在同手术一样重要的地位上。
关健词：术后谵妄；老年患者；髋关节置换术；非药物性预防；集束化干预；实施科学
|
Research Progress on Non-Pharmacological Prevention of Delirium in Elderly Patients Following Single-Laternal Hip Replacement Surgery
|
Yuan Zhang
Rugao Branch of Nantong University Affiliated Hospital, Department of Geriatric Medicine, Rugao Jiangsu 226500 , China
|
Abstract：Objective To systematically review current research on non-pharmacological prevention strategies for postoperative delirium in elderly patients undergoing single-lateral hip replacement surgery, and to explore the process of translating evidence- based findings into clinical practice. Methods This study systematically analyzed domestic and international literature, covering postoperative delirium in a multifactorial etiology model, non-pharmacological intervention strategies during perioperative phases (preoperative, intraoperative, and postoperative), and their evidence-based support. Additionally, it examined practical challenges encountered during implementation and future development trends using scientific theory. Results Existing research indicates that postoperative delirium arises from the interaction of predisposing factors and multiple triggers. Non-pharmacological prevention requires continuous effort spanning the entire perioperative period, including preoperative risk assessment and rehabilitation for high-risk patients, optimized anesthesia management during surgery, and postoperative implementation of comprehensive care protocols such as the Hospital Living Program (HELP), early mobilization, sleep induction, and cognitive guidance. Current challenges in this field have shifted from insufficient evidence to difficulties in translating evidence into practical applications. Conclusion Delirium prevention after elderly hip replacement surgery should transition from passive pharmacological treatment to an active, multidisciplinary non-pharmacological intervention model. The main task going forward is to use science to promote a cultural shift in the clinic that places the maintenance of the patient’s brain health on the same level of importance as surgery.
Keywords : Postoperative delirium; elderly patients; hip replacement; non-pharmacological prevention; cluster intervention;scientific implementation
参考文献
[1] 方敏, 高兴莲, 柯稳, 等. 老年患者髋关节置换术后谵妄危险因素的Meta 分析 [J]. 护理学杂志, 2023, 38(15): 101-106.
[2] Qi YM, Li YJ, Zou JH, Qiu XD, Sun J, Rui YF. Risk factors for postoperative delirium in geriatric patients with hip fracture: A systematic review and meta-analysis. Front Aging Neurosci. 2022 Aug 3;14:960364.
[3] Wilson JE, Mart MF, Cunningham C, Shehabi Y, Girard TD, MacLullich AMJ, Slooter AJC, Ely EW. Delirium. Nat Rev Dis Primers. 2020 Nov 12;6(1):90.
[4] Fong TG, Inouye SK. The inter-relationship between delirium and dementia: the importance of delirium prevention. Nat Rev Neurol. 2022 Oct;18(10):579-596.
[5] Zhao Q, Liu S, Zhao H, Dong L, Zhu X, Liu J. Non-pharmacological interventions to prevent and treat delirium in older people: An overview of systematic reviews. Int J Nurs Stud. 2023 Dec;148:104584.
[6] 刘硕, 黄雨佳, 史宇欣, 等. 主动脉置换术后谵妄的评估与非药物护理的研究进展 [J]. 护理研究, 2024, 38(11): 1954-1959.
[7] Ormseth CH, LaHue SC, Oldham MA, Josephson SA, Whitaker E, Douglas VC. Predisposing and Precipitating Factors Associated With Delirium: A Systematic Review. JAMA Netw Open. 2023 Jan 3;6(1):e2249950.
[8] Smith CJ, Hodge D, Harrison FE, Williams Roberson S. The Pathophysiology and Biomarkers of Delirium. Semin Neurol. 2024 Dec;44(6):720-731.
[9] 王艳艳, 廖玉麟, 岳冀蓉. 从谵妄的血清生物标志物探讨谵妄发生机制 [J]. 生物医学工程学杂志, 2017,34 (03): 465-470.
[10] 张绍刚, 周田田, 陈一林, 等. 术中alpha 功率在认知储备与老年患者非心脏手术后谵妄间的中介作用 [J].临床麻醉学杂志, 2025, 41 (09): 912-917.
[11] 龚财芳, 庞铭, 李欲晓, 等. 肝移植受者术后谵妄的影响因素 [J]. 器官移植, 2025, 16 (05): 812-818.
[12] 徐子恒, 高凤莉, 靳斌, 等. 术前国际标准化比值与肝移植患者术后谵妄的非线性关系研究 [J]. 军事护理,2025, 42 (05): 68-72.
[13] 唐秀芳, 王宏刚, 邢海林. 腹腔镜结直肠癌根治术患者术后谵妄的预测模型 [J]. 临床麻醉学杂志, 2025,41 (04): 346-351.
[14] 李焕楠. 老年结直肠癌患者根治术后谵妄发生影响因素 [J]. 航空航天医学杂志, 2024, 35 (05): 595-598.
[15] 高升润, 李晨, 王亮, 等. 术前血浆总胆固醇水平预测食管癌切除患者术后谵妄的价值 [J]. 实用医学杂志,2025, 41 (07): 1004-1009.
[16] 白洋, 王洁, 曾敏, 等. 额颞部肿瘤切除术后谵妄的危险因素分析 [J]. 临床麻醉学杂志, 2025, 41 (03): 246-250.
[17] Soares MR, Mahanna Gabrielli E, Manjarrez EC. The Geriatric Patient: Frailty, Prehabilitation, and Postoperative Delirium. Med Clin North Am. 2024 Nov;108(6):1101-1117.
[18] Zietlow KE, Wong S, Heflin MT, McDonald SR, Sickeler R, Devinney M, Blitz J, Lagoo-Deenadayalan S, Berger M. Geriatric Preoperative Optimization: A Review. Am J Med. 2022 Jan;135(1):39-48.
[19] Bhushan S, Huang X, Duan Y, Xiao Z. The impact of regional versus general anesthesia on postoperative neurocognitive outcomes in elderly patients undergoing hip fracture surgery: A systematic review and meta-analysis. Int J Surg. 2022 Sep;105:106854.
[20] 潘春峰, 李向辉, 孙庆江. 右美托咪定复合麻醉深度对人工髋关节置换术老年患者术后谵妄的影响 [J].中国老年学杂志, 2024, 44 (10): 2387-2390.
[21] 邱灿金, 刘孝国, 陈燕勤, 等. 髂筋膜阻滞联合罗哌卡因混合右美托咪定和地塞米松对老年全髋关节置换术患者术后谵妄及血流动力学的影响 [J]. 中国老年学杂志, 2024, 44 (09): 2097-2100.
[22] 华豪, 何滕, 李鑫, 等. 艾司氯胺酮主导无阿片麻醉对老年患者全髋关节置换术术后谵妄的影响 [J]. 中国临床药理学与治疗学, 2025, 30 (01): 78-84.
[23] 印建军, 肖亚芬, 田敏, 等. 术中持续输注艾司氯胺酮对老年患者髋关节置换术后谵妄的影响 [J]. 临床麻醉学杂志, 2025, 41 (02): 119-124.
[24] 任红, 周广伟, 付莉莉, 等. 小剂量艾司氯胺酮对老龄髋关节置换术患者术后谵妄的影响 [J]. 解放军医学院学报, 2023, 44 (08): 857-861.
[25] 赵德彩, 闫声明, 王忠涵, 等. 围术期颊针疗法对高龄患者髋关节置换术后谵妄的影响 [J]. 临床麻醉学杂志, 2025, 41 (03): 263-267.
[26] Mart MF, Williams Roberson S, Salas B, Pandharipande PP, Ely EW. Prevention and Management of Delirium in the Intensive Care Unit. Semin Respir Crit Care Med. 2021 Feb;42(1):112-126.
[27] 吴琼, 方曙静, 王广玲, 等. 基于ERAS 理念的集束化护理方案对老年髋部骨折患者术后谵妄的影响 [J].川北医学院学报, 2025, 40 (09): 1220-1224.
[28] 周小竹, 闫莎莎. 集束化护理干预对食管癌患者术后康复及谵妄的影响 [J]. 护理实践与研究, 2023, 20(18): 2784-2789.
[29] 李晓昕, 张燕. 围术期集束化护理预防老年口腔癌手术患者术后下肢深静脉血栓形成及谵妄的效果分析[J]. 河南外科学杂志, 2025, 31 (05): 183-186.
[30] 焦瑞娜, 邢林波, 张喜艳, 等. 基于HELP 模式的骨科老年病人术后谵妄中医联合干预方案的构建与应用[J]. 护理研究, 2023, 37 (24): 4492-4497.
[31] Smith HAB, Besunder JB, Betters KA, Johnson PN,Srinivasan V, Stormorken A, Farrington E, Golianu B, Godshall AJ, Acinelli L, Almgren C, Bailey CH, Boyd JM, Cisco MJ, Damian M, deAlmeida ML, Fehr J, Fenton KE, Gilliland F, Grant MJC, Howell J, Ruggles CA, Simone S, Su F, Sullivan JE, Tegtmeyer K, Traube C, Williams S, Berkenbosch JW. 2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility. Pediatr Crit Care Med. 2022 Feb 1;23(2):e74-e110.
[32] 罗莹, 周慧鹏, 李宏, 等. 羟考酮联合舒芬太尼用于老年骨科全麻患者术后自控镇痛的临床研究 [J]. 中国临床药理学杂志, 2024, 40 (23): 3400-3404.
[33] Burton JK, Craig LE, Yong SQ, Siddiqi N, Teale EA, Woodhouse R, Barugh AJ, Shepherd AM, Brunton A, Freeman SC, Sutton AJ, Quinn TJ. Non-pharmacological interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev. 2021 Jul 19;7(7):CD013307.
[34] Lee Y, Lee J, Kim J, Jung Y. Non-Pharmacological Nursing Interventions for Prevention and Treatment of Delirium in Hospitalized Adult Patients: Systematic Review of Randomized Controlled Trials. Int J Environ Res Public Health. 2021 Aug 22;18(16):8853.
[35] 张玉芬, 汪晖, 胡凯利, 等. 非药物干预对心脏大血管手术患者术后谵妄影响的网状Meta 分析 [J]. 护理学杂志, 2023, 38 (01): 34-39.
[36] 王蒙蒙, 温苑明, 邓永芳, 等. 患儿术后谵妄非药物管理的最佳证据总结 [J]. 中华护理杂志, 2021, 56 (05):762-766.
[37] Lewis K, Balas MC, Stollings JL, McNett M, Girard TD, Chanques G, Kho ME, Pandharipande PP, Weinhouse GL, Brummel NE, Chlan LL, Cordoza M, Duby JJ, Gélinas C, Hall-Melnychuk EL, Krupp A, Louzon PR, Tate JA, Young B, Jennings R, Hines A, Ross C, Carayannopoulos KL, Aldrich JM. A Focused Update to the Clinical Practice Guidelines for the Prevention and Management of Pain, Anxiety, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med. 2025 Mar 1;53(3):e711-e727.
[38] 宋春梅, 吴娟. ICU 护士对谵妄病人管理经验质性研究的Meta整合 [J]. 护理研究, 2020, 34 (04): 613-620.
[39] Aldecoa C, Bettelli G, Bilotta F, Sanders RD, Aceto P, Audisio R, Cherubini A, Cunningham C, Dabrowski W, Forookhi A, Gitti N, Immonen K, Kehlet H, Koch S, Kotfis K, Latronico N, MacLullich AMJ, Mevorach L, Mueller A, Neuner B, Piva S, Radtke F, Blaser AR, Renzi S, Romagnoli S, Schubert M, Slooter AJC, Tommasino C, Vasiljewa L, Weiss B, Yuerek F, Spies CD. Update of the European Society of Anaesthesiology and Intensive Care Medicine evidence-based and consensus- based guideline on postoperative delirium in adult patients. Eur J Anaesthesiol. 2024 Feb 1;41(2):81-108.
[40] 徐燕, 曹艳佩, 任学芳, 等. 神经外科患者术后谵妄非药物预防的循证护理实践 [J]. 复旦学报( 医学版),2021, 48 (06): 791-797.
[41] 刘苗, 罗健, 黄海燕, 等. 非药物干预预防ICU获得性谵妄相关系统评价的再评价 [J]. 护理学杂志, 2020,35 (01): 77-82.
[42] 李梅, 丁永艳, 付沫. 老年谵妄评估及干预策略研究现状 [J]. 护理研究, 2022, 36 (09): 1601-1606.
[43] 张进, 肖正权, 聂菁, 等. 肿瘤重症患者发生亚谵妄综合征影响因素及护理方案的构建及应用 [J]. 实用医学杂志, 2022, 38 (12): 1548-1552.
[44] 刘桂英, 王阳阳, 徐克珮, 等. 成人患者谵妄管理指南的质量评价 [J]. 中国循证医学杂志, 2020, 20 (07):837-844.
[45] 樊溶榕, 李旭英, 魏涛, 等. 终末期患者谵妄的研究进展 [J]. 中华护理杂志, 2021, 56 (02): 295-299.
|
|
|
论文收录证明 / 文献检索报告
Document Retrieval Certificate / Proof of Publication Indexing
作者贡献声明 / 贡献确认书
Author Contribution Statement / Certificate of Authorship Contribution
同行评审报告 / 评审意见
Peer Review Report / Peer Review Comments
利益冲突
Conflict of Interest
作者声明不存在任何利益冲突。
The author declares no conflict of interest.
|
|
