苏醒期谵妄的研究进展

Research Progress on Emergence Delirium

摘要: 苏醒期谵妄(Emergence Delirium, ED)作为全身麻醉后急性神经精神综合征，核心表现为意识混乱、定向障碍及激越行为，在儿科与老年群体呈现高发性。目前临床上对ED不够重视以及不能及时识别。ED的诱因涵盖生理状态、手术方式、麻醉策略及疼痛刺激等多因素。目前其防治依赖于药物与非药物的综合干预。尽管ED病程短暂，但会显著损害患者身心健康，延长住院时间并增加医疗负担。值得注意的是，ED是术后谵妄(Postoperative Delirium, POD)的独立危险因素，ED患者发生POD的风险显著升高。因此，对ED进行早期预测、识别和干预具有重要临床意义。本综述基于近年研究进展，从ED危险因素、预测模型、预防策略及治疗方法等方面系统梳理证据，旨在为临床管理提供循证思路。

Abstract: Emergence delirium (ED), an acute neuropsychiatric syndrome following general anesthesia, is characterized by core manifestations of consciousness confusion, disorientation, and agitated behavior. It exhibits high incidence in pediatric and elderly populations. Currently, ED remains clinically overlooked and frequently underrecognized. The etiology of ED encompasses multifactorial elements including physiological status, surgical procedures, anesthetic strategies, and nociceptive stimuli. Its prevention and management rely on integrated pharmacological and non-pharmacological interventions. Although typically transient in duration, ED significantly compromises patients’ physical/mental health, prolongs hospitalization, and increases healthcare costs. Notably, ED serves as an independent risk factor for postoperative delirium (POD), with ED patients demonstrating substantially elevated POD susceptibility. Consequently, early prediction, identification, and intervention for ED carry crucial clinical significance. This review synthesizes recent advancements by systematically examining evidence across key domains: diagnostic criteria, risk factors, predictive models, preventive strategies, and therapeutic approaches for ED, aiming to provide evidence-based guidance for clinical management.