目的 了解年齡與激素對重癥監(jiān)護(hù)病房(intensive care unit,ICU)患者術(shù)后并發(fā)精神障礙的影響.
方法 以2001年8月至2004年1月解放軍總醫(yī)院ICU收治的388例術(shù)后患者為研究對象,調(diào)查ICU術(shù)后精神障礙的發(fā)生情況.針對"ICU患者中老齡和單次使用大劑量激素是否是術(shù)后發(fā)生精神障礙的主要危險因素"提出問題,以主題詞"postoperative cognitive confusion"和"intensive care"檢索MEDLINE(1968～2004),尋找相關(guān)證據(jù).
結(jié)果 388例患者中術(shù)后并發(fā)精神障礙10例,占3.1%,其中9例為≥65歲的老年患者,占90%.本組ICU老年患者(≥65歲)術(shù)后精神障礙的發(fā)病率為6.6 %(9/136),≤65歲的患者為0.4 %(1/252),表明老年患者發(fā)病率較高(P＜0.05).單次使用甲基強的松龍≥1 000 mg的患者發(fā)病率為7.0 %(5/71),而單次使用甲基強的松龍＜1 000 mg的患者發(fā)病率為1.6 %(5/317),提示激素用量大的患者發(fā)病率較高(P＜0.05).
結(jié)論 結(jié)合文獻(xiàn)檢索回顧, ICU患者中老齡和單次使用大劑量激素是術(shù)后并發(fā)精神障礙的主要危險因素之一.
引用本文： 周飛虎,宋青,何蕾,馬迎民,潘亮,謝菲. 年齡與激素對ICU患者術(shù)后并發(fā)精神障礙的影響. 中國循證醫(yī)學(xué)雜志, 2004, 04(10): 734-736. doi: 復(fù)制
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- 1. ［1］Abildstrom H, Rasmussen LS, Rentowl P, Hanning CD, Rasmussen H, Kristensen PA, Moller JT. Cognitive dysfunction 1-2 years after non-cardiac surgery in the elderly ISPOCD group. International Study of Post-Operative Cognitive Dysfunction [J]. Acta Anaesthesiol Scand, 2000; 44(10): 1 246-1 251.
- 2. ［2］Dijkstra JB, Jolles J. Postoperative cognitive dysfunction versus complaints: a discrepancy in long-term findings [J]. Neuropsychol Rev, 2002; 12(1): 1-14.
- 3. ［3］Johnson T, Monk T, Rasmussen LS. Postoperative cognitive dysfunction in middle-aged patients [J]. Anesthesiology, 2002; 96(6): 1 351-1 357.
- 4. ［4］Rasmussen LS, Moller JT. Central nervous system dysfunction after anesthesia in the geriatric patient [J]. Anesthesiol Clin North America, 2000; 18(1): 59-70.