ICU患者术后并发精神障碍的危险因素分析

Analysis of the risk factors for postoperative confusion in a surgical intensive care unit

目的 :分析外科重症监护病房 (SICU)手术后患者并发精神障碍的危险因素。方法 :选取 2 0 0 1年 8月至 2 0 0 4年 1月我院SICU收治的 388例手术后入科的连续患者作为研究对象。参照中国精神疾病分类方案与诊断标准第 2版修订本 (CCMD2R)躯体疾病所致精神障碍诊断标准 ,调查SICU术后精神障碍的发生情况。并用病例对照的研究方法进行研究 ,术后并发精神障碍的患者为病例组 ,未并发精神障碍的患者为对照组。比较两组患者年龄和使用大剂量激素等因素对术后并发精神障碍的影响。结果 :388例患者手术后并发精神障碍的共有 10例 (3.1% ) ,其中 9例为≥ 6 5岁的老年患者 ,占发生精神障碍的 90 %。SICU老年患者 (≥ 6 5岁 )手术后精神障碍的发病率为 6 .6 % (9/ 136 ) ,非老年患者为 0 .4 % (1/ 2 5 2 ) ,老年患者发病率较高 (P <0 .0 5 )。单次使用甲泼尼龙≥ 10 0 0mg的患者发病率 7.0 % (5 / 71) ,单次使用甲泼尼龙 <10 0 0mg的患者 1.5 % (5 / 317) ,激素用量大的患者发病率较高 (P <0 .0 5 )。结论

Objective:To analyse the risk factors for postoperative confusion in a surgical intensive care unit. Methods:388 consecutive patients in our surgical intensive care unit were retrospectively studied and classified into two groups. Patients with postoperative delirium were group A, the others were group B. Results:Postoperative confusion occurred in 3.1% of 388 patients. The incidence of the aging population older than 65 were 6.6 %(9/136)and that of the other younger population were 0.4 %(1/252). The incidence of patients used methylprednisolone no less than1000mg a bolus were significantly higher than the other patients(P<0.05). Conclusions:Older age and large dosage corticosteroid were the risk factors for postoperative confusion.