摘要
目的 分析讨论老年心力衰竭合并谵妄患者的干预方法。方法 选择我院1例因“呼吸困难4小时”入院的老年心力衰竭患者合并谵妄患者为对象，对于本例患者借助老年综合评估，评估患者存在谵妄的危险因素，对其诊疗及后续干预进行观察总结。结果 该例患者治疗后1周，患者谵妄改善，神志清楚，应答切题，计算力和定向力恢复明显。结论 对于老年心力衰竭合并谵妄患者的治疗中需进行去除诱因、营养干预、睡眠干预、定向刺激以及早期康复锻炼等方面治疗，能有效改善患者症状，提高治疗效果。
关键词： 谵妄；心力衰竭；老年人
Abstract
Objective To analyze and discuss the intervention methods of elderly patients with heart failure complicated with delirium. Methods An elderly patient with heart failure and delirium who was admitted to our hospital due to "dyspnea for 4 hours" was selected as the object. The risk factors of delirium in this patient were assessed by comprehensive assessment of the elderly, and the diagnosis, treatment and follow-up intervention were observed and summarized. Results One week after treatment, the patient's delirium improved, the consciousness was clear, the response was relevant, and the calculation and orientation were recovered obviously. Conclusion In the treatment of senile patients with heart failure complicated with delirium, it is necessary to remove the inducement, nutrition intervention, sleep intervention, targeted stimulation and early rehabilitation exercise, which can effectively improve the symptoms of patients and improve the therapeutic effect.
Key words： Delirium; Heart failure; Old people
参考文献 References
[1] Mattison M. Delirium[J]. Ann Intern Med, 2020,173(7): ITC49-ITC64.
[2] Honda S, Nagai T, Sugano Y, et al. Prevalence, determinants, and prognostic significance of delirium in patients with acute heart failure[J]. Int J Cardiol, 2016,222: 521-527.
[3] Rizzi MA, Torres Bonafonte OH, Alquezar A, et al. Prognostic value and risk factors of delirium in emergency patients with decompensated heart failure[J]. J Am Med Dir Assoc, 2015,16(9): 799.e1-6.
[4] Ampadu J, Morley JE. Heart failure and cognitive dysfunction[J]. Int J Cardiol, 2015,178:12-23.
[5] Correale M, Altamura M, Carnevale R, et al. Delirium in heart failure[J]. Heart Fail Rev, 2020,25(5):713-723.
[6] Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people[J]. Lancet, 2014,383(9920):911-922.
[7] Meagher DJ, Morandi A, Inouye SK, et al. Concordance between DSM-IV and DSM-5 criteria for delirium diagnosis in a pooled database of 768 prospectively evaluated patients using the delirium rating scale-revised-98[J]. BMC Med, 2014,12:164.
[8] 中华医学会神经病学分会神经心理与行为神经病学学组. 综合医院谵妄诊治中国专家共识(2021)[J].中华老年医学杂志,2021,40(10):1226-1233.
[9] Chinese experts consensus on diagnosis and treatment of delirium in general hospital(2021)[J].Chinese Journal of Geriatrics,2021,40(10):1226-1233.
[10] Young J, Murthy L, Westby M, et al. Diagnosis, prevention, and management of delirium: summary of NICE guidance[J]. BMJ, 2010,341:c3704.
[11] 单黎丽.老年心力衰竭合并谵妄患者的临床特点分析[J].安徽卫生职业技术学院学报,2011,10(4):20-21.