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成人苏醒延迟及苏醒期谵妄

Author
Sher-Lu Pai, MD
Section Editor
Natalie F Holt, MD, MPH
Deputy Editor
Nancy A Nussmeier, MD, FAHA
Translators
韩如泉, 主任医师

引言

全身麻醉后患者不能及时恢复正常意识，可能表现为苏醒延迟或苏醒期谵妄。大多数情况下，这些情况是暂时性的，并且随着麻醉药物的代谢和清除而逐渐缓解。罕见情况下，其原因是需要紧急干预的严重躯体或神经系统疾病。

本文将总结全身麻醉后苏醒延迟和苏醒期谵妄的原因及处理。术后持久谵妄的处理将单独讨论。 (参见“谵妄和精神错乱状态的诊断”)

在麻醉后监测治疗室(post-anesthesia care unit, PACU)中发生的其他问题将单独讨论。 (参见“麻醉后恢复室内并发症概述”)

正常的苏醒

苏醒是指在手术结束时停止给予麻醉药和辅助药物后患者意识的逐渐恢复。大多数患者可平稳地从手术麻醉状态(Ⅲ阶段)过渡到有完整保护性反射的清醒状态(Ⅰ阶段)(表 1)[1]。患者在手术室苏醒后，通常是在患者拔管后且在自主呼吸情况下氧合和通气充足、血流动力学稳定，且可被唤醒以遵从简单的口头指令(如睁眼或握手)时，被转送至PACU的。

大多数患者在拔管后大约15分钟内意识恢复充分(即，清醒及知道周围环境和身份)，在末次给予任何镇静剂、阿片类物质或麻醉药物后60分钟内所有患者都应该有反应[2-4]。然而，患者恢复意识所需时间存在一定差异，取决于多种因素：采用的具体麻醉药物；末次给药用法用量、持续时间和时机；手术类型及手术持续时间，以及患者术前的躯体和精神状态。 (参见下文‘危险因素’)

                

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Literature review current through: 2017-07 . | This topic last updated: 2017-06-06.
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