老年患者结直肠癌术后精神功能障碍原因分析

Analysis of postoperative psychonosema for elder patients with colorectal carcinoma

目的:了解麻醉方法及年龄因素对术后发生精神功能障碍的影响,及精神功能障碍发生时间、持续时间、性质与对症处理的药物选择。方法:回顾分析结、直肠癌术后患者1298例,其中全麻450例,硬膜外麻醉398例,全麻复合硬膜外450例。70岁以下652例,70岁以上646例。男性777例,女性521例。结果:术后出现精神功能障碍128例,因术中大出血而血压波动26例。麻醉方法为全麻22例,硬膜外78例,全麻复合硬膜外28例。发生急性精神功能障碍的时间为术后第0.5～10d,平均(3.2±1.6)d,症状持续1～4d,平均(2.2±1.2)d。随访1～12个月未再发作。结论:麻醉方法与循环波动、年龄对术后精神功能障碍有影响,而性别无影响。术后一旦发现精神症状,在排除器质性病变的情况下,早期给予相应的抗精神病药物治疗,预后良好。

Objective： To evaluate the effectiveness of different anesthesia methods and age on the occurrence of postoperative psychonosema and the measurement of drug treatment. Methods： A total of 1 298 cases with colorectal carcinoma were studied. Among them, 450 cases received general anesthesia, 398 received epidural anesthesia, and 450 underwent combined anesthesia. 646 cases were elder than 70 years old while the other 652 ones were younger than 70. The male and female patients were 777 and 521 respectively. Results： 128 cases on postoperatirp psychonosema, 26 cases on blood pressone fluctuation that are caused by postoperatirp maisive haemorrhage, 22 cases are general anesthesia, 78 cases are epidural anesthosia, 28 cases are underwent combined anesthesia. The occurrence of acute postoperative psychonosema ranged from half to ten days after operation with a mean time of （3.2±1.6） days. The symptoms continued 1 to 4 days and the average maintenance was （2.2±1.2） days. There were no recurrence during consequential follow-up for 6 to 12 months. Conclusion： Age, anesthesia method and the circulation fluctuation are significantly etiological factors for postoperative psychonosema while gender is not. Looking for the promotive factors and giving antipsychotic agents early are necessary for good prognosis if the patient presented with postoperative psychonosema.