悬雍垂腭咽成形术后发生精神障碍表现的临床分析

Analysis of Psychiatric Disorder after Uvulopalatopharyngoplasty

【目的】描述悬雍垂腭咽成形术后发生精神障碍的临床表现，对诊断和鉴别诊断进行临床分析，为相似病症的治疗提供参考。【方法】描述3例悬雍垂腭咽成形术后发生精神障碍的病例的详细临床表现以及处理过程。【结果】例1，25岁男性，术后2h因受隔壁抢救声音刺激发病，具有憋气咽部异物感的手术苏醒过程的再体验感，拔掉输液管和监护电极并拒绝任何治疗的逃避现象，害怕出现生命危险，彻夜未眠的高警觉性表现，诊断为急性应激障碍。2d后缓解。例2，45岁女性，术后5d出现持续的偏执和抑郁和强迫状态，一度出现幻听和妄想症状，诊断为反应性精神病，经奋乃静和氟哌啶醇治愈。例3，46岁男性，术后出现情绪兴奋、言语增多、重复词语、肢体配合语言，睡眠少等现象，口服安定效果不佳，3d后缓解。【结论】临床上应区别各种精神障碍的诊断，并作出相应的临床处置，对于急性应激障碍和反应性精神病的患者，最重要的是防止过激行为导致严重后果，同时需要专科医师指导和药物治疗。

[Objeetive]To understand the differential diagnosis among acute stress disorders, reactive psychosis and post-traumatic stress disorder by analyzing case reports. [Methods]The data of 3 cases suffering from psychiatric disorder after uvulopalatopharyngoplasty were described in detail, and the clinical manifestations and treating process were also delineated. [Results]Case one （aged 25 years old, male） was diagnosed as acute stress disorders because of acute episode within a few minutes after hearing about salvage noise happened in next door, and was just sent back ward after uvulopalatopharyngoplasty 2 hours later. The symptom with hypervigilance represented insomnia and fear for sedatives causing him to death, flight reaction signed on plucking plate electrode of monitor and needle of travenol infuser and refusal of treatment, pseudo-dyspnea and globus pharynges as if re experience of palinesthesia during operation. He was over excitation and going to jump out of the high building window, but prohibited. His symptoms were relieved after 2 days. Case two （aged 45 years old, female） was diagnosed as reactive psychosis because of the symptoms such as auditory hallucination, paranoia, coercion and depression. The symptoms happened 5 days after uvulopalatopharyngoplasty. She was cured by taking chlorperphenazine and serenelfi. Case three （aged 46 years old, male） represented exaltation, talkativeness, nagging,verbigeration and insufficient sleep after operation. He took diazepam orally, but no effect was found. After 3 days, his symptoms were relieved. [Conclusion] It is very important to recognize psychiatric disorder after operation so as to adopt suitable therapy, The most important handling is to avoid extreme behavior just like suicide such as ease one.