FAKTORI RIZIKA ZA NASTANAK POSTOPERATIVNOG DELIRIJUMA
Sažetak
Pojava postoperativnog delirijuma (POD) prepoznata je poslednjih decenija kao važan klinički sindrom, naročito kod starijih bolesnika koji se podvrgavaju hirurškom lečenju. Cilj ovog preglednog rada se odnosio na ispitivanje preoperativnih, intraoperativnih i postoperativnih faktora koji mogu da dovedu do nastanka POD. Faktori rizika za nastanak POD su brojni, a što je najznačajnije, mnogi se mogu modifikovati. Neki od najznačajnijih faktora rizika za nastanak POD su starije životno doba, zloupotreba alkohola, preoperativno lošiji funkcionalni i kognitivni status, prisustvo depresije i demencije. Veća učestalost javljanja POD zabeležena je kod pacijenata podvrgnutih kompleksnijim operativnim zahvatima kao što su kardiohirurške, vaskularne i ortopedske operacije frakture kuka. Uočeno je da nakon hitnih operativnih zahvata POD se 1,5 do 3 puta češće javlja nego kod elektivnih planiranih operativnih procedura. Takođe, intraoperativno krvavljenje i primena transfuzije su identifikovani kao značajni faktori rizika za nastanak POD. Da bi se izbegli kognitivni deficiti uzrokovani dužom ekspozicijom anesteziji, istraživanja su pokazala da titracija anestetika praćenjem bispektralnog indeksa, kao i evociranih auditivnih potencijala, može smanjiti prekomernu izloženost anesteticima i samim tim smanjiti rizik od postoperativne kognitivne disfunkcije. Poznavanje faktora rizika i identifikacija pacijenata sa povećanim rizikom predstavljaju osnovu strategije za prevenciju ovog sindroma. Trenutni dokazi sugerišu da perioperativno izbegavanje upotrebe benzodijazepina, kao i adekvatna perioperativna kontrola bola, predstavljaju ključne mere za redukciju rizika od POD.
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