心脏手术后精神障碍

Postoperative Psychosis After Heart Surgery

目的：探讨心脏手术后精神障碍的病因、发病机制及防治措施。方法：观察２０５３例心脏手术病人，其中出现术后精神障碍者由专科医师诊断认定并提供治疗方案。结果：５４例病人出现精神障碍，其中体外循环术后发生率（３．１２％）与非体外循环术后发生率（１．４７％）之间存在显著性差异（Ｐ＜０．０５）。术前心功能较差者，更易出现精神障碍（Ｐ＜０．０１）。病人均为成年，表现为躁狂状态、抑郁状态、精神分裂样状态及神经症性反应，预后良好。结论：术后精神障碍主要与精神因素、体外循环损伤、心功能状况等有关，强调精神因素所起的作用，应采取综合治疗及预防。

Objective:To study the aetiology,pathogenesis,prophylaxis and management measures for psychosis following cardiac surgery. Methods:Two thousand and fifty three cases were observed.The patients with psychiatric complications were diagnosed and treated by psychiatrist. Results:Fifty four cases had psychiatric complications.The incidences in non cardiopulmonary bypass and cardiopulmonary bypass were 1 47% and 3 12%( p <0 05),respectively.The incidence increased with the severity of preoperative cardiac disease( p <0 01).All patients with postcardiotomy psychosis were adults.The symptoms of postcardiotomy psychosis were manic state,depressive state,schizophrenia like state and neurosis reaction.The prognosis of the patients was good. Conclusion:Postcardiotomy psychosis is mainly related with the psychological factors,the damage of bypass and the severity of cardiac disease.The psychological factors are emphasized.Comprehensive treatment and prevention measures should be taken.