死亡后器官捐献供肾移植术后躁狂性精神障碍的临床分析

Clinical Analysis of Manic Mental Disorder after Deceased Donor Kidney Transplantation

目的探讨死亡后器官捐献(DD)供肾移植术后躁狂性精神障碍的临床特征、病因及防治。方法回顾性分析11例DD供肾移植术后躁狂性精神障碍患者的临床资料。结果5例症状较轻者,予约束带约束四肢后48 h内症状自行消失。4例应用不同程度镇静药物后症状逐渐消失,其中1例在治疗期间出现嗜睡。1例患者活动剧烈,短时间内地西泮、氟哌啶醇、异丙嗪均不能控制症状,突发移植肾破裂,切除移植肾。1例患者症状反复,最后地西泮、氟哌啶醇、异丙嗪效果均不佳,转入ICU气管插管持续镇静,2 d后拔除气管插管,意识良好,转回普通病房。结论DD供肾移植术后躁狂性精神障碍是多种因素综合作用的结果,可直接影响患者预后,对其进行及时适当的治疗非常重要。

Objective To investigate the clinical features,etiology,prevention and treatment of manic mental disorder after deceased donor(DD)kidney transplantation.Methods Clinical data of 11 patients with manic mental disorder after DD kidney transplantation were retrospectively analyzed.Results In the 5 patients with mild symptoms,the symptoms automatically disappeared within 48 hours after the restraint was applied to the limbs.Symptoms gradually disappeared after treatment with sedatives in 4 patients,and 1 of them developed lethargy during treatment.In a hyperactive patient,symptoms could not be controlled by diazepam,haloperidol and promethazine in a short time,and the transplanted kidney was removed due to sudden rupture.One patient had recurrent symptoms,but the effects of diazepam,haloperidol and promethazine were not satisfactory.Then,this patient was transferred to ICU for endotracheal intubation and continued sedation.Two days later,the endotracheal intubation was removed and the patient was transferred back to general ward with good consciousness.Conclusion Manic mental disorder after DD kidney transplantation is a result of multiple factors,which directly affects the prognosis of patients and is particularly important for timely and appropriate treatment.