查看文章

Delirium, an acute mental syndrome caused by organic factors, is a common complication of surgery in elderly people [165, 172], but it has attracted little attention until recently and is often unrecognized or misdiagnosed by medical staff [12, 117]. Apart from its frequency, there are several reasons why this syndrome is important in the older surgical patient. Delirium is often the presenting feature of physical illness or drug toxicity [105, 111] and failure to appreciate this may lead to delay in diagnosing and treating the underlying cause. Complications of immobility and of sedation, such as decubitus ulcers and chest infections, are common in patients with prolonged delirium [10, 55, 167]. Delirium may cause considerable distress and agitation, and there is a high risk of self injury [14, 90, 176]. Economic implications include the need for extra nursing care, increased duration of hospital stay and a high rate of discharge to long-term care [100, 159]. The diagnosis, investigation and treatment of postoperative delirium in the elderly are important to many specialties and discussion of these topics is widely dispersed in the literature. The aim of this article is to review the current state of knowledge of delirium and to determine areas requiring further research.