成人术后谵妄预防与护理专家共识

doi:10.3761/j.issn.2096-7446.2025.07.011

摘要/Abstract

摘要：

目的制订成人术后谵妄预防与护理的专家共识（以下简称《共识》），以指导成人术后谵妄的护理。方法检索国内外数据库及相关网站中关于成人术后谵妄的指南、专家共识、系统评价、原始研究等，检索时限为建库至2024年5月。通过文献查阅、利益相关者访谈、专家讨论会，撰写《共识》初稿。2024年12月—2025年1月，邀请19名专家进行2轮函询，对初稿内容进行修改完善，确定证据级别及推荐强度，形成《共识》终稿。结果《共识》内容包含成人术后谵妄的分型、危险因素、评估与识别、预防及护理5个方面。结论该共识可为临床护理人员提供成人术后谵妄预防与护理的实践指导。

关键词: 成人, 术后谵妄, 预防, 护理, 专家共识

Abstract:

Objective To develop an expert consensus on the prevention and nursing care of postoperative delirium in adults（hereinafter referred to as the“consensus”），to guide the nursing of postoperative delirium in adults. Methods The guidelines，expert consensuses，systematic reviews，and original studies related to postoperative delirium in adults were searched in domestic and international databases and related websites，with the search period from the establishment of the database to May 2024. The first draft of the consensus was written through literature review，stakeholder interviews and expert meeting. From December 2024 to January 2025，19 experts were invited to conduct two rounds of letter consultation，revise and improve the content of the first draft，determine the level of evidence and recommendation strength，and form the final draft of the consensus. Results The content of the “consensus” includes five aspects：classification，risk factors，assessment and identification，prevention，and nursing care of postoperative delirium in adults. Conclusion This consensus can provide practical guidance for clinical nursing staff in the prevention and nursing care of postoperative delirium in adults.

Key words: Adults, Postoperative Delirium, Prevention, Nursing Care, Expert Consensus

中华护理学会外科护理专业委员会, 重庆医科大学附属第一医院护理部/神经外科/血管外科/重症医学科, 华中科技大学同济医学院附属同济医院护理部, （执笔：刘丽萍，张萍，朱桦，吴前胜，张川林，刘佳莉，秦静雯，刘美言）. 成人术后谵妄预防与护理专家共识[J]. 中华急危重症护理杂志, 2025, 6(7): 837-842.

Surgical Nursing Professional Committee of Chinese Nursing Association , Nursing Department/Neurosurgery/Vascular Surgery/Critical Care Medicine，The First Affiliated Hospital of Chongqing Medical University , Department of Nursing，Tongji Hospital，Tongji Medical College，Huazhong University of Science and Technology , （Writing Committee：LIU Liping，ZHANG Ping，ZHU Hua，WU Qiansheng，ZHANG Chuanlin，LIU Jiali，QIN Jingwen，LIU Meiyan） . Expert consensus on the prevention and nursing of postoperative delirium in adults[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(7): 837-842.

参考文献 36

[1]	Association AP. Diagnostic and statistical manual of mental di-sorders[M]. 5th ed. Washington,DC: American Psychiatric Asso-ciation, 2013.
[2]	White NC, Cowart CR, Cios TJ. Pharmacological prevention of postoperative delirium in adults:a review of recent literature[J]. Curr Neurol Neurosci Rep, 2024, 24(12):681-689.
[3]	Gleason LJ, Schmitt EM, Kosar CM, et al. Effect of delirium and other major complications on outcomes after elective surgery in older adults[J]. JAMA Surg, 2015, 150(12):1134-1140. doi: 10.1001/jamasurg.2015.2606 pmid: 26352694
[4]	Cai S, Li J, Gao J, et al. Prediction models for postoperative delirium after cardiac surgery:systematic review and critical appraisal[J]. Int J Nurs Stud, 2022, 136:104340.
[5]	吴前胜, 曾莹, 王兰, 等. 体外循环下心脏手术患者术后谵妄管理的循证实践[J]. 中华护理杂志, 2024, 59(3):292-299. doi: 10.3761/j.issn.0254-1769.2024.03.007
	Wu QS, Zeng Y, Wang L, et al. Evidence-based nursing pra-ctice of postoperative delirium management during cardiac surgery under cardiopulmonary bypass[J]. Chin J Nurs, 2024, 59(3):292-299.
[6]	王志稳, 韩舒羽. 护理领域专家共识论文的质量评价要点[J]. 中华护理杂志, 2024, 59(3):267-270. doi: 10.3761/j.issn.0254-1769.2024.03.002
	Wang ZW, Han SY. The key points of quality criteria for expert consensus papers in nursing[J]. Chin J Nurs, 2024, 59(3):267-270. doi: 10.3761/j.issn.0254-1769.2024.03.002
[7]	Oxford Centre for Evidence-Based Medicine. Oxford centre for evidence-based medicine:levels of evidence(March 2009)[EB/OL]. (2009-03)[2024-09-05]. https://www.cebm.ox.ac.uk/resources/le-vels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009.
[8]	中国老年医学学会麻醉学分会, 米卫东, 王国林, 等. 中国老年患者术后谵妄防治专家共识[J]. 国际麻醉学与复苏杂志, 2023, 44(1):1-27.
	Anesthesiology Branch of the Chinese Geriatrics Society, Mi WD, Wang GL, et al. Expert consensus on the prevention and treatment of postoperative delirium in elderly patients in China[J]. Int J Anesthesiol Resusc, 2023, 44(1):1-27.
[9]	中国医疗保健国际交流促进会心脏重症分会. 心脏及大血管术后谵妄的防治中国专家共识[J]. 中华医学杂志, 2023, 103(45):3635-3644.
	Cardiac Critical Care Branch of China International Exchange and Promotive Association for Medical and Health. Chinese expert consensus on the prevention and treatment of posto-perative delirium of cardiovascular surgery[J]. Nat Med J China, 2023, 103(45):3635-3644.
[10]	Karageorgos V, Mevorach L, Silvetti M, et al. Preoperative risk factors associated with increased incidence of postoperative delirium:systematic review of qualified clinical studies[J]. Geriatrics, 2023, 8(1):24.
[11]	Zhang YJ, Yu YJ, Han ZY, et al. Incidence and associated factors of delirium after primary total joint arthroplasty in elderly patients:a systematic review and meta-analysis[J]. Me-dicine, 2024, 103(22):e38395.
[12]	Hughes CG, Boncyk CS, Culley DJ, et al. American society for enhanced recovery and perioperative quality initiative joint consensus statement on postoperative delirium prevention[J]. Anesth Analg, 2020, 130(6):1572-1590. doi: 10.1213/ANE.0000000000004641 pmid: 32022748
[13]	裴锋博, 姚垚, 史晨, 等. 心脏外科体外循环术后谵妄的危险因素分析[J]. 中华胸心血管外科杂志, 2023, 39(12):750-753.
	Pei FB, Yao Y, Shi C, et al. Analysis of risk factors for pos-toperative delirium after extracorporeal circulation in cardiac surgery[J]. Chin J Thorac Cardiovasc Surg, 2023, 39(12):750-753.
[14]	He KQ, Wang S, Zhang W, et al. What is the impact of perio-perative cerebral oxygen desaturation on postoperative deli-rium in old population:a systemic review and meta-analysis[J]. Aging Clin Exp Res, 2022, 34(8):1761-1770.
[15]	Zhang HJ, Ma XH, Ye JB, et al. Systematic review and meta-analysis of risk factor for postoperative delirium following spinal surgery[J]. J Orthop Surg Res, 2020, 15(1):509. doi: 10.1186/s13018-020-02035-4 pmid: 33153465
[16]	Aldecoa C, Bettelli G, Bilotta F, et al. Update of the European Society of Anaesthesiology and Intensive Care Medicine evide-nce-based and consensus-based guideline on postoperative delirium in adult patients[J]. Eur J Anaesthesiol, 2024, 41(2):81-108.
[17]	Inouye SK, van Dyck CH, Alessi CA, et al. Clarifying confu-sion:the confusion assessment method. A new method for detection of delirium[J]. Ann Intern Med, 1990, 113(12):941-948. doi: 10.7326/0003-4819-113-12-941 pmid: 2240918
[18]	梅伟, 刘尚昆, 张治国, 等. 中文版护理谵妄筛查量表的信度和效度研究[J]. 中华护理杂志, 2010, 45(2):101-104.
	Mei W, Liu SK, Zhang ZG, et al. The validity and reliability of the Chinese version of nursing delirium screening scale[J]. Chin J Nurs, 2010, 45(2):101-104.
[19]	Sessler DI, Pei LJ, Li K, et al. Aggressive intraoperative warm-ing versus routine thermal management during non-cardiac sur-gery(PROTECT):a multicentre,parallel group,superiority trial[J]. Lancet, 2022, 399(10337):1799-1808. doi: 10.1016/S0140-6736(22)00560-8 pmid: 35390321
[20]	Wesselink EM, Kappen TH, Torn HM, et al. Intraoperative hy-potension and the risk of postoperative adverse outcomes:a systematic review[J]. Br J Anaesth, 2018, 121(4):706-721. doi: S0007-0912(18)30376-3 pmid: 30236233
[21]	An R, Pang QY, Liu HL. Association of intra-operative hypo-tension with acute kidney injury,myocardial injury and mor-tality in non-cardiac surgery:a meta-analysis[J]. Int J Clin Pract, 2019, 73(10):e13394.
[22]	Wang LC, Lang ZK, Gao HY, et al. The relationship between the incidence of postoperative cognitive dysfunction and intraoperative regional cerebral oxygen saturation after car-diovascular surgery:a systematic review and meta-analysis of randomized controlled trials[J]. Rev Cardiovasc Med, 2022, 23(12):388.
[23]	Chew WZ, Teoh WY, Sivanesan N, et al. Bispectral index(BIS) monitoring and postoperative delirium in elderly patients undergoing surgery:a systematic review and meta-analysis with trial sequential analysis[J]. J Cardiothorac Vasc Anesth, 2022, 36(12):4449-4459.
[24]	Sumner M, Deng C, Evered L, et al. Processed electroencepha-lography-guided general anaesthesia to reduce postoperative de-lirium:a systematic review and meta-analysis[J]. Br J Anaes-th, 2023, 130(2):e243-e253.
[25]	Pearson, Vincent. Delirium(adults):non-pharmacological preven-tion and management in acute care[EB/OL].(2024-04-17)[2024-08-01]. https://ovidsp.dc1.ovid.com/ovid-new-b/ovidweb.cgi?&S=main&Complete+Reference=S.sh.42%7c1%7c1&Counter5=SS_view_found_complete%7cJBI14502%7cjbi%7cjbidb%7cjbi&Counter5Data=JBI14502%7cjbi%7cjbidb%7cjbi.
[26]	Sosnowski K, Lin F, Chaboyer W, et al. The effect of the ABCDE/ABCDEF bundle on delirium,functional outcomes,and quality of life in critically ill patients:a systematic review and meta-analysis[J]. Int J Nurs Stud, 2023, 138:104410.
[27]	Vasunilashorn SM, Guess J, Ngo L, et al. Derivation and vali-dation of a severity scoring method for the 3-minute diagno-stic interview for confusion assessment method:defined delirium[J]. J Am Geriatr Soc, 2016, 64(8):1684-1689. doi: 10.1111/jgs.14234 pmid: 27374833
[28]	Fernandes F, Santos M, Anacleto AM, et al. Nursing interven-tion to prevent and manage delirium in critically ill patients:a scoping review[J]. Healthcare, 2024, 12(11):1134.
[29]	Swarbrick CJ, Partridge JL. Evidence-based strategies to redu-ce the incidence of postoperative delirium:a narrative review[J]. Anaesthesia, 2022, 77(Suppl 1):92-101.
[30]	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.
	Neuropsychology and Behavioral Medical Section of Neurology Credit Association of Chinese Medical Association. Chinese experts consensus on diagnosis and treatment of delirium in general hospital(2021)[J]. Chin J Geriatr, 2021, 40(10):1226-1233.
[31]	袁娜娜, 朱光宇, 郑爽, 等. 针对性心理护理在心脏外科ICU综合征中的应用效果[J]. 中华现代护理杂志, 2017, 23(31):4031-4033.
	Yuan NN, Zhu GY, Zheng S, et al. Application effect of the pertinent metal nursing in ICU syndrome in the department of cardiac surgery[J]. Chin J Mod Nurs, 2017, 23(31):4031-4033.
[32]	Esfahanian F, Mirmohammadsadeghi A, Gholami H, et al. Using music for the prevention of delirium in patients after coronary artery bypass graft surgery:a randomized clinical trial[J]. J Cardiothorac Vasc Anesth, 2022, 36(12):4341-4346. doi: 10.1053/j.jvca.2022.09.007 pmid: 36241502
[33]	Ou-Yang CL, Ma LB, Wu XD, et al. Association of sleep qua-lity on the night of operative day with postoperative delirium in elderly patients:a prospective cohort study[J]. Eur J Anaes-thesiol, 2024, 41(3):226-233.
[34]	Travers R, Gagliardi G, Ramseyer M. Delirium management in perioperative geriatric services:a narrative review of non-phar-maceutical strategies[J]. Front Psychiatry, 2024, 15:1394583.
[35]	Herman J, Urman RD, Urits I, et al. Which interventions can reduce post-operative delirium in the elderly? Synthesis of multidisciplinary and pharmacological intervention data[J]. J Clin Anesth, 2022, 79:110117.
[36]	Veronese N, Solimando L, Bolzetta F, et al. Interventions to pre-vent and treat delirium:an umbrella review of randomized controlled trials[J]. Ageing Res Rev, 2024, 97:102313.