课件：POD手术后患者谵妄认知障碍的专家共识.ppt

Conclusion POD is a frequent complication and requires preventive measures as well as immediate and adequate treatment. Although numerous studies have documented the clinical and economic consequences of POD, systematic interventions aimed to reduce its incidence and duration are rarely implemented. (1) preoperative evaluation of POD risk and identification of patients at risk (2) communication about this risk to patients, their family and care team members (3) best possible preoperative conditions to be achieved (4) perioperative avoidance of use of anticholinergic agents and benzodiazepines except when needed. Benzodiazepines can be considered in cases of alcohol withdrawal (5) attempts to reduce surgical stress, together with organ-protective intraoperative management, including neuromonitoring to avoid excessively deep anaesthesia (a) effective multimodal opioid-sparing analgesia (b) implementation of enhanced recovery programmes (6) cognitive monitoring to be aimed at recognition of preoperative cognitive decline and to detect POD as early as possible, including in the recovery room (7) effective treatment of POD by protocols (8) follow-up of POD patients all along their hospital stay (9) patient information on adequate medical support, to ensure continuity of care after discharge. Thank you for your attention ? ? ? ? ? ? ? . Definition Delirium is an acute and fluctuating alteration of mental state of reduced awareness and disturbance of attention. POD often starts in the recovery room and occurs up to 5 days after surgery. Very early onset of POD in the immediate postanaesthesia period before or on arrival at the recovery room is referred to as ‘emergence delirium Delirium can present as hypoactive (decreased alertness, motor activity and anhedonia), as hyperactive (agitated and combative) or as mixed forms. Increased age seems to be a predisposing factor for the hypoactive form. The prognosis may be worse with hypoactive delirium, possibly due to relat