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J Neurocrit Care 2010;3(2): 27-37.
신경계 집중치료 환자에서 발생하는 섬망의 임상적 접근
구 본 대1·홍 종 희2
관동대학교 의과대학 명지병원 신경과학교실,1 임상시험센터2
Clinical Approach to the Patients with Delirium in the Neurocritical Care
Bon D. Ku, MD, PhD1 and Jong Hee Hong, RN2
1Department of Neurology, 2Clinical Trial Center, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
Delirium is a common life-threatening and potentially preventable clinical syndrome. It occurs in up to 70% of patients having neurocritical care. The cause of delirium is multifactorial. Delirium and dementia are highly interrelated and dementia is the leading risk factor for delirium. Specific brain areas especially prefrontal cortex and neurotransmitters especially acetylcholine play an important role in the development of the delirium. Underlying diseases such as stroke, head trauma or dementia make patients more vulnerable to the delirium. Nonpharmacologic therapy should be instituted, including a calm, comfortable environment with the use of orienting influences. Pharmacologic management should be considered for patients whose symptoms would threaten their own safety or the safety of other persons. Therapeutic drug options include atypical neuroleptics or antidepressants. In this review, we discuss the clinical approach and pathophysiology of the delirium focus on the neurocritical management.
Key Words: Delirium · Neurocritical care · Clinical approach
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