術後精神障害の背景因子の検討 [in Japanese] BACKGROUND FACTORS OF POSTOPERATIVE PSYCHIATRIC DISORDER [in Japanese]
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術後精神障害(Postoperative psychiatric disorder,以下PPD)は,外科診療の場で日常経験される病態である.われわれはこの対策を検討するために,当科の全身麻酔手術患者1,057例について, PPD発症の背景因子につき検討した.<br> PPDは145人(13.7%)に認められ,平均術後2.7日で発症した.高齢者,男性,長手術時間, ICU長期在室,低Ccr値,高ICG値,術後長期禁食,脳神経疾患の既往,悪性疾患非告知例などで有意に高率であったが,緊急手術か否かでは有意差がなかった.<br> 非告知例に発症率が高いことより,告知を伴う十分なinformed consentがPPDの予防に有効である可能性が示唆された.術前からPPDを念頭に置いた説明を患者と家族に対して行うなど,総合的な対策の確立が急務である. PPDは80歳以上では約40%で惹起される合併症である.この高発症頻度を考慮すると,今後人口の高齢化に伴う高齢者手術の増加で,より大きな問題となると予想される.
Postoperative psychiatric disorder (PPD) is a common problem in general surgery. We reviewed the clinical records of 1057 patients who underwent our operation under general anesthesia, and examined the background factors of PPD.<br> One hundred and forty-five (13.7% of all) patients presented some symptoms of PPD, such as delirium. Their onset was about 2.7 days on an average, postoperatively. PPD occurred more frequently in older patients, men, and those with a longer operation time, longer ICU stay, shorter Ccr time, higher ICG level, longer preoperative fasting period, those who had a past history of brain disease, and those who were not informed definitively about their malignancy. However, no significant difference in the incidence rate between emergency and no-emergency cases.<br> PPD was more common in patients who did not informed about their malignancy. The informed consent may decrease the occurrence of PPD. We have to consider some total management for PPD. For example, we give some information to a patient and his family about PPD during a preoperative hospitalization, and cope with his or her disease together. The problem of PPD will be more important in the near future, because the number of elderly patients will increase.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 57(8), 1807-1812, 1996-08-25
Japan Surgical Association