CAJ | 학술논문

目的：回顾性总结老年患者在人工髋／膝关节置换术后发生急性精神障碍的原因和防治措施。方法2006年1月至2011年12月，本组收治70岁以上老年人工关节患者1650例，出现术后精神障碍67例，发生率为4.1％。分析这67例患者精神障碍出现时间、持续时间，麻醉方式、麻醉用药、髋膝手术方式、基础疾病和电解质失衡情况与术后精神障碍的关系。结果精神障碍多发生于术后6h～5d内，主要表现有谵妄、定向力障碍、躁动、烦躁不安、神智不清、嗜睡、胡言乱语、昼夜颠倒等。术后3.77％椎管内麻醉和4.10％全身麻醉患者出现急性精神障碍，但两者无统计学差异。髋关节置换术组出现精神障碍的比例为5.09％，显著高于膝关节置换术组的2.39％。67例精神障碍患者中合并有高血压42例（62.7％），合并糖尿病39例（58.2％），合并酗酒18例（26.9％）。67例精神障碍患者中术后电解质检查提示低钾（50例，74.7％）、低钠（42例，62.7％）、低钙血症（37例，55.2％），合并低氧血症52例，占77.6％。结论高龄、基础疾病、电解质紊乱、低氧血症和术后疼痛是人工髋／膝关节置换术后发生急性精神障碍的高危因素。术前应重视和纠正老年患者各种病理状态，加强围术期呼吸循环的管理，防止低血压、低氧血症、脑水肿的发生，术后给予良好的镇痛和人文关怀，尽量消除促使术后精神障碍发生的各种因素。
목적：회고성총결노년환자재인공관／슬관절치환술후발생급성정신장애적원인화방치조시。방법2006년1월지2011년12월，본조수치70세이상노년인공관절환자1650례，출현술후정신장애67례，발생솔위4.1％。분석저67례환자정신장애출현시간、지속시간，마취방식、마취용약、관슬수술방식、기출질병화전해질실형정황여술후정신장애적관계。결과정신장애다발생우술후6h～5d내，주요표현유섬망、정향력장애、조동、번조불안、신지불청、기수、호언란어、주야전도등。술후3.77％추관내마취화4.10％전신마취환자출현급성정신장애，단량자무통계학차이。관관절치환술조출현정신장애적비례위5.09％，현저고우슬관절치환술조적2.39％。67례정신장애환자중합병유고혈압42례（62.7％），합병당뇨병39례（58.2％），합병후주18례（26.9％）。67례정신장애환자중술후전해질검사제시저갑（50례，74.7％）、저납（42례，62.7％）、저개혈증（37례，55.2％），합병저양혈증52례，점77.6％。결론고령、기출질병、전해질문란、저양혈증화술후동통시인공관／슬관절치환술후발생급성정신장애적고위인소。술전응중시화규정노년환자각충병리상태，가강위술기호흡순배적관리，방지저혈압、저양혈증、뇌수종적발생，술후급여량호적진통화인문관부，진량소제촉사술후정신장애발생적각충인소。
Objective To analyze the causes and treatment of postoperative acute mental disorders after total hip or knee arthroplasty in the elderly .Methods From January 2006 to December 2011, 1650 patients over 70 years old were admitted , among which 67 cases were postoperative acute mental disorders , the incidence was 4.1%.The onset time of acute mental disorder , duration, anesthesia method , anesthetic drugs, surgical method, electrolyte imbalance and basic diseases of the 67 cases were all analysed.Results The acute mental disorders occured in the postoperative 6 h to 5 d, and the main symptoms were delirium , disorientation, agitation, irritability, confusion, drowsiness, nonsense, and day-and-night inversion. 3.77% of the patients using spinal anesthesia and 4.10% of the patients using general anesthesia developed postoperative acute mental disorders , but the difference was not statistically significant between the two groups .5.09%of the patients in the hip arthroplasty group developed postoperative acute mental disorders, which was significantly higher than that in the knee arthroplasty group (2.39%).Among the 67 patients with acute mental disorders , 42 patients ( 62.7%) had high blood pressure , 39 patients (58.2%) had diabetes mellitus, 18 patients ( 26.9%) were alcoholism abuse.The postoperative electrolyte examinations showed hypokalemia in 50 cases (74.7%), hyponatremia in 42 cases(62.7%), hypocalcemia in 37 cases(55.2%), and hypoxemia in 52 cases (77.6%).Conclusions Pain, old age, basic diseases , electrolyte imbalance , hypovolemia and hypoxemia are the risk factors of postoperative acute mental disorders after total hip or knee arthroplasty .Attentions should be paid to various pathological states of elderly patients before the operation .The management of respiratory and circulation system should be improved to prevent hypotension , hypoxemia , cerebral edema , and good analgesia and humane care should be given to eliminate the risk factors .