Shiiba M, Takei M, Nakatsuru M, Bukawa H, Yokoe H, Uzawa K, Tanzawa H
Department of Dentistry and Oral Surgery, Chiba University Hospital, Chiba University, Chiba city, Chiba, Japan.
Int J Oral Maxillofac Surg. 2009 Jun;38(6):661-5. doi: 10.1016/j.ijom.2009.01.011. Epub 2009 Feb 23.
The aim of the present study was to clarify the clinical characteristics of postoperative delirium and to determine appropriate postoperative management for its prevention. The authors analysed 132 cases of primary surgery for oral carcinoma and observed 24 (18%) cases of postoperative delirium. Univariate analysis revealed that significant risk factors for postoperative delirium were older age, male gender, extensive surgery and morphine pain control. Logistic regression analysis showed that older age and male gender were significant risk factors for postoperative delirium, while patient-controlled analgesia with fentanyl was effective for prevention of postoperative delirium. There was a trend for postoperative delirium to be associated with extensive surgery. In those who had delirium, blood tests revealed that alkaline phosphatase, total protein, sodium, chlorine, red blood cell count, haemoglobin and haematocrit were significantly diminished after surgery. These results indicate that general condition is closely related to the onset of postoperative delirium, and suggest that appropriate postoperative management can reduce the incidence of this complication.
本研究的目的是阐明术后谵妄的临床特征，并确定预防术后谵妄的适当术后管理措施。作者分析了132例口腔癌一期手术病例，观察到24例（18%）术后谵妄病例。单因素分析显示，术后谵妄的显著危险因素为年龄较大、男性、广泛手术和吗啡镇痛。逻辑回归分析表明，年龄较大和男性是术后谵妄的显著危险因素，而芬太尼患者自控镇痛对预防术后谵妄有效。术后谵妄有与广泛手术相关的趋势。在发生谵妄的患者中，血液检查显示术后碱性磷酸酶、总蛋白、钠、氯、红细胞计数、血红蛋白和血细胞比容显著降低。这些结果表明，一般状况与术后谵妄的发生密切相关，并提示适当的术后管理可降低该并发症的发生率。
