アブストラクト
Japanese
| Title | 高齢者における周術期のせん妄と睡眠障害 |
|---|---|
| Subtitle | 日本臨床麻酔学会第40回大会シンポジウム「高齢者・超高齢者における周術期麻酔管理の特徴と問題点」 |
| Authors | 位田みつる*, 川口昌彦* |
| Authors (kana) | |
| Organization | *奈良県立医科大学麻酔科学教室 |
| Journal | 日本臨床麻酔学会誌 |
| Volume | 42 |
| Number | 2 |
| Page | 160-166 |
| Year/Month | 2022 / |
| Article | 報告 |
| Publisher | 日本臨床麻酔学会 |
| Abstract | [要旨] 周術期のせん妄と睡眠障害は患者素因に環境の変化や周術期の因子が加わり生じる. 術後の認知機能障害は研究により定義が異なることがあったが, 2018年に明確に定義された. 高齢であることは術後せん妄の危険因子であるが介入しにくい. 一方で, フレイルに代表される低い身体機能や軽度認知機能障害を含めた術前の認知機能低下などは介入可能な因子として注目されている. 慢性不眠はせん妄のリスクである. また, 入院後に生じる急性不眠は手術3カ月後の生活機能と関係していた. 当院では認知機能や睡眠をターゲットに五感と想感に働きかけるEffective Medical Creationの効果を検証している. |
| Practice | 臨床医学：外科系 |
| Keywords | せん妄, 認知機能, 睡眠障害, 生活機能, Effective Medical Creation, Delirium, Cognitive function, Sleep disturbance, Functional disability |
English
| Title | Perioperative Delirium and Sleep Disturbance in Aged Patients |
|---|---|
| Subtitle | |
| Authors | Mitsuru IDA, Masahiko KAWAGUCHI |
| Authors (kana) | |
| Organization | Department of Anesthesiology, Sara Medical University |
| Journal | The Journal of Japan Society for Clinical Anesthesia |
| Volume | 42 |
| Number | 2 |
| Page | 160-166 |
| Year/Month | 2022 / |
| Article | Report |
| Publisher | The Japan Society for Clinical Anesthesia |
| Abstract | Perioperative delirium and sleep disturbances result from environmental changes and perioperative stress in predisposed patients. Postoperative cognitive dysfunction has been defined variously in previous studies, but was clearly defined in 2018. Aged patients tend to experience postoperative delirium, but age is a fixed factor. On the other hand, low physical function as represented by frailty and preoperative cognitive decline including mild cognitive impairment are modifiable factors. Chronic insomnia is also a risk factor for the development of delirium. In addition, acute insomnia occurring after hospitalization was related to functional disability 3 months after surgery. We are examining the effects of Effective Medical Creation (EMC), which involves stimulation of the five senses and thoughts/impressions on cognitive function and sleep. |
| Practice | Clinical surgery |
| Keywords | Delirium, Cognitive function, Sleep disturbance, Functional disability, Effective Medical Creation |
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参考文献
- 1) Tiret L, Desmonts JM, Hatton F, et al.: Complications associated with anaesthesia--a prospective survey in France. Can Anaesth Soc J 33 : 336-344, 1986
- 2) Jin F, Chung F : Minimizing perioperative adverse events in the elderly. Br J Anaesth 87 : 608-624, 2001
- 3) Evered L, Silbert B, Knopman DS, et al.: Recommen-dations for the nomenclature of cognitive change asso-ciated with anaesthesia and surgery-2018. Can J Anaesth 65 : 1248-1257, 2018
- 4) American Psychiatric Association : Diagnostic and Statistical Manual of Mental Disorders, 5th ed. APA Press, Washington, DC, 2013
- 5) World Health Organization : The ICD-10 classification of mental and behavioural disorders : diagnostic crite-ria for research. World Health Organization, 1993
残りの30件を表示する
- 6) Wei LA, Fearing MA, Sternberg EJ, et al.: The Con-fusion Assessment Method : a systematic review of current usage. J Am Geriatr Soc 56 : 823-830, 2008
- 7) Inouye SK, Leo-Summers L, Zhang Y, et al.: A chart-based method for identification of delirium : validation compared with interviewer ratings using the confu-sion assessment method. J Am Geriatr Soc 53 : 312-318, 2005
- 8) Mahanna-Gabrielli E, Zhang K, Sieber FE, et al.: Frailty Is Associated With Postoperative Delirium But Not With Postoperative Cognitive Decline in Older Noncardiac Surgery Patients. Anesth Analg 130 : 1516-1523, 2020
- 9) Altman MT, Knauert MP, Murphy TE, et al.: Associa-tion of intensive care unit delirium with sleep distur-bance and functional disability after critical illness : an observational cohort study. Ann Intensive Care 8 : 63, 2018
- 10) Ida M, Takeshita Y, Kawaguchi M : Preoperative se-rum biomarkers in the prediction of postoperative de-lirium following abdominal surgery. Geriatr Gerontol Int 20 : 1208-1212, 2020
- 11) Bruce AJ. Ritchie CW, Blizard R, et al.: The incidence of delirium associated with orthopedic surgery : a me-ta-analytic review. Int Psychogeriatr 19 : 197-214, 2007
- 12) Saczynski JS, Marcantonio ER, Quach L, et al.: Cogni-tive trajectories after postoperative delirium. N Engl J Med 367 : 30-39, 2012
- 13) Newman MF, Kirchner JL, Phillips-Bute B, et al.: Longitudinal assessment of neurocognitive function af-ter coronary-artery bypass surgery. N Engl J Med 344 : 395-402, 2001
- 14) Guenther U, Riedel L, Radtke FM : Patients prone for postoperative delirium : preoperative assessment, peri-operative prophylaxis, postoperative treatment. Curr Opin Anaesthesiol 29 : 384-390, 2016
- 15) Susano MJ, Grasfield RH, Friese M, et al.: Brief Pre-operative Screening for Frailty and Cognitive Impair-ment Predicts Delirium after Spine Surgery. Anesthesiology 133 : 1184-1191, 2020
- 16) Brown CH 4th, Max L, LaFlam A, et al.: The Associa-tion Between Preoperative Frailty and Postoperative Delirium After Cardiac Surgery. Anesth Analg 123 : 430-435, 2016
- 17) Tjeertes EKM, van Fessem JMK, Mattace-Raso FUS, et al.: Influence of Frailty on Outcome in Older Pa-tients Undergoing Non-Cardiac Surgery-A System-atic Review and Meta-Analysis. Aging Dis 11 : 1276-1290, 2020
- 18) Stern Y : Cognitive reserve in ageing and Alzheimer's disease. Lancet Neurol 11 : 1006-1012, 2012
- 19) Amado LA, Perrie H, Scribante J, et al.: Preoperative cognitive dysfunction in older elective noncardiac sur-gical patients in South Africa. Br J Anaesth 125 : 275-281, 2020
- 20) Gaulton TG, Eckenhoff RG, Neuman MD : Prevalence and Multivariable Factors Associated With Preopera-tive Cognitive Impairment in Outpatient Surgery in the United States. Anesth Analg 129 : e5-e7, 2019
- 21) Schaefer ST, Koenigsperger S, Olotu C, et al.: Bio-markers and postoperative cognitive function : could it be that easy? Curr Opin Anaesthesiol 32 : 92-100, 2019
- 22) Kotfis K, Slozowska J, Safranow K, et al.: The Practi-cal Use of White Cell Inflammatory Biomarkers in Pre-diction of Postoperative Delirium after Cardiac Sur-gery. Brain Sci 9 : 308, 2019
- 23) Todd OM, Gelrich L, MacLullich AM, et al.: Sleep Dis-ruption at Home As an Independent Risk Factor for Postoperative Delirium. J Am Geriatr Soc 65 : 949-957, 2017
- 24) Wang JP, Lu SF, Guo LN, et al.: Poor preoperative sleep quality is a risk factor for severe postoperative pain after breast cancer surgery : A prospective co-hort study. Medicine(Baltimore) 98 : e17708, 2019
- 25) Orbach-Zinger S, Fireman S, Ben-Haroush A, et al.: Preoperative sleep quality predicts postoperative pain after planned caesarean delivery. Eur J Pain 21 : 787-794, 2017
- 26) Su X, Wang DX : Improve postoperative sleep : what can we do? Curr Opin Anaesthesiol 31 : 83-88, 2018
- 27) Park MJ, Yoo JH, Cho BW, et al.: Noise in hospital rooms and sleep disturbance in hospitalized medical patients. Environ Health Toxicol 29 : e2014006, 2014
- 28) Moore JT, Kelz MB : Opiates, sleep, and pain : the adenosinergic link. Anesthesiology 111 : 1175-1176, 2009
- 29) Leung JM, Sands LP, Newman S, et al.: Preoperative Sleep Disruption and Postoperative Delirium. J Clin Sleep Med 11 : 907-913, 2015
- 30) Ida M, Onodera H, Yamauchi M, et al.: Preoperative sleep disruption and postoperative functional disability in lung surgery patients : a prospective observational study. J Anesth 33 : 501-508, 2019
- 31) Romagnoli S, Villa G, Fontanarosa L, et al.: Sleep du-ration and architecture in non-intubated intensive care unit patients : an observational study. Sleep Med 70 : 79-87, 2020
- 32) Su X, Meng ZT, Wu XH, et al.: Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery : a randomised, double-blind, placebo-controlled trial. Lancet 388 : 1893-1902, 2016
- 33) 川口昌彦, 位田みつる, 武澤恵理子ほか : 当院におけるEffective Medical Creation(EMC)による認知機能障害予防の試み. 日本臨床麻酔学会誌 40 : 384-391, 2020
- 34) Inoue S, Takezawa E, Kawaguchi M : Effective Medi-cal Creation(EMC)-A New Approach to Improve-ment of Patient Management in the Standpoint of Hos-pital Room Environment. Open Journal of Anesthesiology 10 : 409-421, 2020
- 35) 井上聡己, 武澤恵理子, 三木光範ほか : 疑似窓, 装飾を施したICUに対する患者, 患者家族へのアンケート. 臨床麻酔 43 : 1125-1128, 2019
