手術後譫妄的預防與護理

Prevention and Nursing Managements of Postoperative Delirium

手術後譫妄對病人的認知功能產生影響，且經常預示著不良的預後結果，包括術後併發症增加、住院時間延長、再住院率提高及死亡率上升等，對個人健康、醫療與社會負擔影響深遠。本篇目的探討術後譫妄相關預防與處置，涵蓋風險因素的識別評估、譫妄症狀的篩檢、術後譫妄非藥物與藥物處置措施。透過文獻回顧了解，早期識別手術後譫妄風險因子與提供預防措施至關重要，發生風險因子包括高齡、多重共病症、酗酒或吸菸、手術麻醉方式、營養不良、睡眠障礙、疼痛等前置與誘發多方面因素，尤其是高齡者、衰弱病人和大型手術後更為常見。臨床照護面，除了首要識別出高風險病患採取跨領域整合性的介入，提供非藥物應優先內科多重共病疾患疾病照護管理外，在提供藥物時應避免使用Benzodiazepines類的抗焦慮鎮靜劑和抗膽鹼藥物，其次是應該注意體液和營養狀態、術中麻醉深度與藥物的使用，降低身體面對手術壓力的生理失衡；最後術後定期監測與記錄病人的精神狀態變化，同時鼓勵家屬參與照護過程，這些措施將有效管理術後譫妄，進而改善病人的治療效果和預後。

After surgery, delirium can impact patients' cognitive function, often indicating poor surgical outcomes such as increased postoperative complications, prolonged hospital stays, higher readmission rates, and increased mortality. These effects have profound implications for personal health, healthcare systems, and societal burdens. This article aims to explore preventive and management strategies related to postoperative delirium, covering the identification and assessment of risk factors, screening for delirium symptoms, and both non-pharmacological and pharmacological interventions. Based on literature reviews, early identification of risk factors for postoperative delirium and providing preventive measures are crucial. Risk factors include advanced age, multiple comorbidities, alcohol or tobacco use, type of anesthesia used during surgery, malnutrition, sleep disorders, and pain, among other predisposing and precipitating factors. Particularly common among older adults, frail patients, and after major surgeries, these factors highlight the necessity for comprehensive interdisciplinary interventions in clinical care. In addition to identifying high-risk patients, clinical care should prioritize non-pharmacological interventions, especially for managing multiple comorbidities in internal medicine. When pharmacological interventions are necessary, it is advised to avoid benzodiazepines and anticholinergic drugs due to their potential adverse effects. Attention should also be given to fluid and nutritional status, depth of anesthesia during surgery, and appropriate medication use to minimize physiological imbalances in response to surgical stress. Lastly, regular monitoring and documentation of patients' mental status changes postoperatively, along with encouraging family involvement in caregiving processes, are essential measures in effectively managing postoperative delirium. These strategies collectively aim to improve treatment outcomes and prognosis for patients affected by delirium after surgery.