综合医院精神科会诊中老年谵妄患者临床资料分析

Analysis on clinical data of elderly in-patients with delirium during psychiatric consultation at Chinese general hospitals

目的了解谵妄在综合医院老年住院患者中的临床特点。方法2008年至2011年内综合医院老年住院患者中经精神科会诊明确诊断为谵妄者364例，采用自编调查表对会诊原因、原发躯体疾病、会诊后药物处理等临床资料进行分析。结果意识障碍（55.2%）和言行紊乱（24.6%）是最常见的请求会诊原因；老年谵妄患者的躯体疾病主要集中在神经系统（25.0%），手术后（24.7%），心血管系统（22.5%）和呼吸系统（19.2%）；83.5%老年患者应用了药物治疗，常用的药物为奥氮平（46.2%）、氟哌啶醇（29.7%）、喹硫平（5.2%）、利培酮（3.8%）和苯二氮类（3.8%）药物，其中奥氮平所占比例从2008年的35.3%上升到2011年的56.9%（P＜0.01），而氟哌啶醇所占比例从2008年的38.2%下降至2011年的19.3%（P＜0.01）。结论老年患者是发生谵妄的高风险人群，尤其是脑梗死、感染、手术后的老年患者更需要重点关注。

Objective To investigate the clinical features of elderly in-patients with delirium in the psychiatric consultations at general hospitals. Methods A total of 364 elderly in-patients （over 65 years old） from general hospitals who were diagnosed as delirium during the psychiatric consultation by our department during 2008 to 2011 were subjected in this study. Detailed clinical data of all subjects were retrospectively surveyed by self-made questionnaire for consultation reasons, primary physical diseases, and drug treatment after consultation, and then summarized and analyzed. Results The most common reasons for psychiatric consultation were disturbance of consciousness （55.2%） and verbal or behavioral confusion （24.6%）. Medical conditions of these subjects were mainly neurological diseases （25.0%）, post-operation （24.7%）, cardiovascular diseases （22.5%） and respiratory diseases （19.2%）. Neuroleptics were administered to 83.5%of the subjects, and they were olanzapine （46.2%）, haloperidol （29.7%）, quetiapine （5.2%）, risperidone （3.8%） and benzodiazepines （3.8%）. During the four years, the proportion of olanzapine was increased from 35.3% in 2008 to 56.9% in 2011 （P〈0.01）, while that of haloperidol was decreased from 38.2% in 2008 to 19.3% in 2011 （P〈0.01）. Conclusion Elderly in-patients are at high-risk of delirium, especially for those with cerebral infarction, infection or after surgery. More attention should be paid to these elderly patients.