脊柱外科患者术后谵妄的临床分析

目的探讨脊柱外科手术患者术后发生谵妄的危险因素和有效防治措施。方法 2007年1月2009年10月应用ICU谵妄诊断的意识状态评估法观察1 835例脊柱外科术后患者。对于发生术后谵妄的患者随机分为治疗组和未治疗组,治疗组于谵妄诊断明确时即静脉注射氟哌利多5mg。结果术后3d,136例发生谵妄,谵妄发生率为7.41%。筛选出术后谵妄的可能高危因素包括高龄、术前合并高血压、术前合并糖尿病、术中出血量〉600mL、手术时间〉4h、术中应用激素、术后电解质紊乱和低氧血症、术后疼痛。发生谵妄的患者中,治疗组（68例）住院时间短于未治疗组（68例）,差异有统计学意义（P〈0.05）。结论高龄,术前合并高血压、糖尿病,术中出血量〉600mL,手术时间〉4h,术中应用激素,术后电解质紊乱、低氧血症及疼痛是脊柱外科手术患者术后发生谵妄的主要高危因素。氟哌利多治疗术后谵妄有效。

Clinical analysis on Phrenitis after Spine Surgery

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（600 mL） during the operation,operative time（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（P0.05）.Conclusions Senility,pre-operative complications of hypertension and diabetes,hemorrhage amount（600 mL） during the operation,operative time（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.