• 天津市人民醫(yī)院脊柱外科（天津，300121）;

【摘要】　目的　 探討脊柱外科手術患者術后發(fā)生譫妄的危險因素和有效防治措施。　方法　 2007年1月-2009年10月應用ICU譫妄診斷的意識狀態(tài)評估法觀察1 835例脊柱外科術后患者。對于發(fā)生術后譫妄的患者隨機分為治療組和未治療組，治療組于譫妄診斷明確時即靜脈注射氟哌利多5 mg。　結果　 術后3 d，136例發(fā)生譫妄，譫妄發(fā)生率為7.41%。篩選出術后譫妄的可能高危因素包括高齡、術前合并高血壓、術前合并糖尿病、術中出血量 gt;600 mL、手術時間 gt;4 h、術中應用激素、術后電解質紊亂和低氧血癥、術后疼痛。發(fā)生譫妄的患者中，治療組（68例）住院時間短于未治療組（68例），差異有統(tǒng)計學意義（P lt;0.05）。　結論　 高齡，術前合并高血壓、糖尿病，術中出血量 gt;600 mL，手術時間 gt;4 h，術中應用激素，術后電解質紊亂、低氧血癥及疼痛是脊柱外科手術患者術后發(fā)生譫妄的主要高危因素。氟哌利多治療術后譫妄有效。
【Abstract】　Objective　 To analyze the related factors influencing postoperative phrenitis in patients who have undergone spine surgery.　Methods　 Postoperative phrenitis was evaluated with the confusion assessment method for the intensive care unit in 1 835 patients underwent spine surgery between January 2007 and October 2009. All the patients with postoperative phrenitis were randomly divided into two groups: treatment group and control group. The patients in treatment group underwent intravenous injection with droperidol (5 mg).　Results　 Three days after the operation, 136 patients were diagnosed with postoperative phrenitis. The pre-operative complications of hypertension and diabetes, hemorrhage amount ( gt;600 mL) during the operation, operative time ( gt;4 hours), hormone usage during the operation, postoperative electrolyte disturbances, hyoxemia and pain were the factors influencing the morbidity of postoperative phrenitis. The length of hospital stay was shorter in the treatment group than that in the control group (P lt;0.05).　Conclusions　 Senility, pre-operative complications of hypertension and diabetes, hemorrhage amount ( gt;600 mL) during the operation, operative time ( gt;4 hours), hormone usage during the operation, postoperative electrolyte disturbances, hyoxemia and pain were the factors influencing the morbidity of postoperative phrenitis. Droperidol is effective on postoperative phrenitis.

引用本文： 孫天威,于斌,李輝南,盧守亮,張杭,張學利. 脊柱外科患者術后譫妄的臨床分析. 華西醫(yī)學, 2011, 26(12): 1828-1831. doi: 復制

版權信息： ?四川大學華西醫(yī)院華西期刊社《華西醫(yī)學》版權所有，未經(jīng)授權不得轉載、改編

1. 　Victor M, Ropper AH. 亞當斯-維克托神經(jīng)病學 [M]. 7版. 北京: 人民衛(wèi)生出版社, 2002: 426-431.
2. 　Pompei P, Foreman M, Rudberg M A, et al. Delirium in hospitalized older persons: outcomes and predictors[J]. J Am Geriatr Soe, 1994, 42(8): 809-815.
3. 　Spronk PE, Riekerk B, Hofhuis J, et al. Occurrence of delirium is severely underestimated in the ICU during daily care[J]. Intensive Care Med, 2009, 35(7): 1276-1280.
4. 　阮靜, 皋源, 杭燕南. 全麻后中樞神經(jīng)系統(tǒng)并發(fā)癥[J]. 中國醫(yī)藥導報, 2007, 9(5): 387-390.
5. 　馬長松, 馬春野. 老年術后譫妄分析[J]. 中國老年學雜志, 1999, 19(2): 72-73.
6. 　Ely EW, I nouye SK, Bernard GR, et al. Delirium in mechanically ventilated pailents:validity and reliability of the confusion assessment method for the intensive care unit(CAM-ICU)[J]. JAMA, 2001, 286(21): 2703-2710.
7. 　Hibberd C, Yau JI, Seckl JR. Glueocorticoids and the ageing hippocampus[J]. J Anat, 2000, 197(4): 553-562.
8. 　McEwen BS. The neurobiology of stress: from serendipity to clinical relevance[J]. Brain Res, 2000, 886(1-2): 172-189.
9. 　Rapeli P, Kivisaari R, Autti T, et al. Cognitive function during early abstinence from opioid dependence:a comparison to age, gender, and verbal intelligence matched controls[J]. BMC Psychiatry, 2006, 6: 9.
10. 　Lynch EP, Lazor MA, Gellis JE, et al. The impact of postoperative pain on the development of postoperative delirium[J]. Anesth Analg, 1998, 86(4): 781-785.
11. 　McCusker J, Cole MG, Dendukuri N, et al. Does delirium increase hospital stay?[J]. J Am Geriatr Soe, 2003, 51(11): 1539-1546.
12. 　姜昕, 張艷春, 韓香淑. 老年患者發(fā)生術后譫妄的臨床研究[J]. 中國醫(yī)藥導報, 2010, 7(10): 12-13.
13. 　Marcantonio ER, Goldman L, Mangione CM, et al. A clincal prediction rule for delirum after elective noncardiac surgery [J]. JMMA, 1994, 271(2): 134-135.
14. 　Aizawa K, Kanai T, Saikawa Y, et al. A novel approach to the prevention of postoperative delirium in the elderly after gastrointestinal surgery[J]. Surg Today, 2002, 32(4): 310-314.
15. 　趙民, 劉偉, 黃宏偉, 等. 小劑量丙泊酚治療老年患者術后譫妄效果觀察[J]. 醫(yī)學理論與實踐, 2009, 22(1): 40-41.
  1. 1. 　Victor M, Ropper AH. 亞當斯-維克托神經(jīng)病學 [M]. 7版. 北京: 人民衛(wèi)生出版社, 2002: 426-431.
  2. 2. 　Pompei P, Foreman M, Rudberg M A, et al. Delirium in hospitalized older persons: outcomes and predictors[J]. J Am Geriatr Soe, 1994, 42(8): 809-815.
  3. 3. 　Spronk PE, Riekerk B, Hofhuis J, et al. Occurrence of delirium is severely underestimated in the ICU during daily care[J]. Intensive Care Med, 2009, 35(7): 1276-1280.
  4. 4. 　阮靜, 皋源, 杭燕南. 全麻后中樞神經(jīng)系統(tǒng)并發(fā)癥[J]. 中國醫(yī)藥導報, 2007, 9(5): 387-390.
  5. 5. 　馬長松, 馬春野. 老年術后譫妄分析[J]. 中國老年學雜志, 1999, 19(2): 72-73.
  6. 6. 　Ely EW, I nouye SK, Bernard GR, et al. Delirium in mechanically ventilated pailents:validity and reliability of the confusion assessment method for the intensive care unit(CAM-ICU)[J]. JAMA, 2001, 286(21): 2703-2710.
  7. 7. 　Hibberd C, Yau JI, Seckl JR. Glueocorticoids and the ageing hippocampus[J]. J Anat, 2000, 197(4): 553-562.
  8. 8. 　McEwen BS. The neurobiology of stress: from serendipity to clinical relevance[J]. Brain Res, 2000, 886(1-2): 172-189.
  9. 9. 　Rapeli P, Kivisaari R, Autti T, et al. Cognitive function during early abstinence from opioid dependence:a comparison to age, gender, and verbal intelligence matched controls[J]. BMC Psychiatry, 2006, 6: 9.
  10. 10. 　Lynch EP, Lazor MA, Gellis JE, et al. The impact of postoperative pain on the development of postoperative delirium[J]. Anesth Analg, 1998, 86(4): 781-785.
  11. 11. 　McCusker J, Cole MG, Dendukuri N, et al. Does delirium increase hospital stay?[J]. J Am Geriatr Soe, 2003, 51(11): 1539-1546.
  12. 12. 　姜昕, 張艷春, 韓香淑. 老年患者發(fā)生術后譫妄的臨床研究[J]. 中國醫(yī)藥導報, 2010, 7(10): 12-13.
  13. 13. 　Marcantonio ER, Goldman L, Mangione CM, et al. A clincal prediction rule for delirum after elective noncardiac surgery [J]. JMMA, 1994, 271(2): 134-135.
  14. 14. 　Aizawa K, Kanai T, Saikawa Y, et al. A novel approach to the prevention of postoperative delirium in the elderly after gastrointestinal surgery[J]. Surg Today, 2002, 32(4): 310-314.
  15. 15. 　趙民, 劉偉, 黃宏偉, 等. 小劑量丙泊酚治療老年患者術后譫妄效果觀察[J]. 醫(yī)學理論與實踐, 2009, 22(1): 40-41.