Clinical analysis on Phrenitis after Spine Surgery_West China Medical Journal

Authors：

SUN Tianwei , YU Bin , LI Huinan , LU Shouliang , ZHANG Hang ,  ZHANG Xueli

Department of Orthopaedics，Tianjin Union Medicine Centre，Tianjin 300121，P. R. China;

Corresponding author：

ZHANG Xueli, Email: billsuntw@163.com

Keywords：

脊柱外科; 谵妄; 氟哌利多; ICU谵妄诊断的意识状态评估法

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【摘要】　目的　探讨脊柱外科手术患者术后发生谵妄的危险因素和有效防治措施。　方法　 2007年1月-2009年10月应用ICU谵妄诊断的意识状态评估法观察1 835例脊柱外科术后患者。对于发生术后谵妄的患者随机分为治疗组和未治疗组，治疗组于谵妄诊断明确时即静脉注射氟哌利多5 mg。　结果　术后3 d，136例发生谵妄，谵妄发生率为7.41%。筛选出术后谵妄的可能高危因素包括高龄、术前合并高血压、术前合并糖尿病、术中出血量 gt;600 mL、手术时间 gt;4 h、术中应用激素、术后电解质紊乱和低氧血症、术后疼痛。发生谵妄的患者中，治疗组（68例）住院时间短于未治疗组（68例），差异有统计学意义（P lt;0.05）。　结论　高龄，术前合并高血压、糖尿病，术中出血量 gt;600 mL，手术时间 gt;4 h，术中应用激素，术后电解质紊乱、低氧血症及疼痛是脊柱外科手术患者术后发生谵妄的主要高危因素。氟哌利多治疗术后谵妄有效。
【Abstract】　Objective　 To analyze the related factors influencing postoperative phrenitis in patients who have undergone spine surgery.　Methods　 Postoperative phrenitis was evaluated with the confusion assessment method for the intensive care unit in 1 835 patients underwent spine surgery between January 2007 and October 2009. All the patients with postoperative phrenitis were randomly divided into two groups: treatment group and control group. The patients in treatment group underwent intravenous injection with droperidol (5 mg).　Results　 Three days after the operation, 136 patients were diagnosed with postoperative phrenitis. The pre-operative complications of hypertension and diabetes, hemorrhage amount ( gt;600 mL) during the operation, operative time ( gt;4 hours), hormone usage during the operation, postoperative electrolyte disturbances, hyoxemia and pain were the factors influencing the morbidity of postoperative phrenitis. The length of hospital stay was shorter in the treatment group than that in the control group (P lt;0.05).　Conclusions　 Senility, pre-operative complications of hypertension and diabetes, hemorrhage amount ( gt;600 mL) during the operation, operative time ( gt;4 hours), hormone usage during the operation, postoperative electrolyte disturbances, hyoxemia and pain were the factors influencing the morbidity of postoperative phrenitis. Droperidol is effective on postoperative phrenitis.

Citation： SUN Tianwei,YU Bin,LI Huinan,LU Shouliang,ZHANG Hang,ZHANG Xueli. Clinical analysis on Phrenitis after Spine Surgery. West China Medical Journal, 2011, 26(12): 1828-1831. doi: Copy

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1. 　Victor M, Ropper AH. 亚当斯-维克托神经病学 [M]. 7版. 北京: 人民卫生出版社, 2002: 426-431.
2. 　Pompei P, Foreman M, Rudberg M A, et al. Delirium in hospitalized older persons: outcomes and predictors[J]. J Am Geriatr Soe, 1994, 42(8): 809-815.
3. 　Spronk PE, Riekerk B, Hofhuis J, et al. Occurrence of delirium is severely underestimated in the ICU during daily care[J]. Intensive Care Med, 2009, 35(7): 1276-1280.
4. 　阮静, 皋源, 杭燕南. 全麻后中枢神经系统并发症[J]. 中国医药导报, 2007, 9(5): 387-390.
5. 　马长松, 马春野. 老年术后谵妄分析[J]. 中国老年学杂志, 1999, 19(2): 72-73.
6. 　Ely EW, I nouye SK, Bernard GR, et al. Delirium in mechanically ventilated pailents:validity and reliability of the confusion assessment method for the intensive care unit(CAM-ICU)[J]. JAMA, 2001, 286(21): 2703-2710.
7. 　Hibberd C, Yau JI, Seckl JR. Glueocorticoids and the ageing hippocampus[J]. J Anat, 2000, 197(4): 553-562.
8. 　McEwen BS. The neurobiology of stress: from serendipity to clinical relevance[J]. Brain Res, 2000, 886(1-2): 172-189.
9. 　Rapeli P, Kivisaari R, Autti T, et al. Cognitive function during early abstinence from opioid dependence:a comparison to age, gender, and verbal intelligence matched controls[J]. BMC Psychiatry, 2006, 6: 9.
10. 　Lynch EP, Lazor MA, Gellis JE, et al. The impact of postoperative pain on the development of postoperative delirium[J]. Anesth Analg, 1998, 86(4): 781-785.
11. 　McCusker J, Cole MG, Dendukuri N, et al. Does delirium increase hospital stay?[J]. J Am Geriatr Soe, 2003, 51(11): 1539-1546.
12. 　姜昕, 张艳春, 韩香淑. 老年患者发生术后谵妄的临床研究[J]. 中国医药导报, 2010, 7(10): 12-13.
13. 　Marcantonio ER, Goldman L, Mangione CM, et al. A clincal prediction rule for delirum after elective noncardiac surgery [J]. JMMA, 1994, 271(2): 134-135.
14. 　Aizawa K, Kanai T, Saikawa Y, et al. A novel approach to the prevention of postoperative delirium in the elderly after gastrointestinal surgery[J]. Surg Today, 2002, 32(4): 310-314.
15. 　赵民, 刘伟, 黄宏伟, 等. 小剂量丙泊酚治疗老年患者术后谵妄效果观察[J]. 医学理论与实践, 2009, 22(1): 40-41.

West China Medical Journal

Clinical analysis on Phrenitis after Spine Surgery

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