综合性医院住院患者中谵妄的临床特点  

Study on the clinical characteristics of delirium in hospitalized patients in a general hospital

作　　者：曲媛[1] 赵媛[1] 韩燕飞[1] 陈葵[1] 张拥波[1] 

机构地区：[1]首都医科大学附属北京友谊医院神经内科,北京100050

出　　处：《临床和实验医学杂志》2015年第8期688-690,共3页Journal of Clinical and Experimental Medicine

摘　　要：目的探讨综合性医院住院患者中发生谵妄的临床特点及治疗策略。方法根据美国精神障碍诊断和统计手册第四版（DSM-Ⅳ）诊断标准,收集2013年1~6月期间申请神经内科会诊确诊的谵妄患者临床资料,并与非谵妄患者进行比较分析。结果共诊断谵妄患者54例,占同期申请会诊患者的12.16%。谵妄患者平均年龄（73.70岁）高于非谵妄患者（64.45岁）,差异有显著性（P〈0.05）,但性别构成比无显著差异（男∶女32∶22 vs.218∶172,χ^2=0.218,P〉0.05）。发生谵妄的患者多来自各个手术科室及重症监护室,高于来自内科患者（62.96%vs.25.6%,χ^2=31.355,P〈0.05）。代谢异常（包括水、电解质紊乱及急性肝、肾功能异常）、低氧血症及重症感染为最常见的诱发因素,疼痛在外科系统也是诱发谵妄的常见因素之一;57.63%患者同时存在2种及以上的诱发因素。谵妄症状集中表现为夜间加重的注意力下降、精神运动性激越、睡眠-觉醒周期紊乱、定向力障碍、错觉或幻觉及记忆力下降。大部分患者在加强原发病治疗、纠正诱发因素后自行缓解。仅7例患者给予短疗程、小剂量的非典型抗精神病药物治疗。结论在综合性医院的住院患者中,病情复杂的老年患者发生谵妄的几率更大。一旦患者出现了谵妄状态,提倡综合性治疗,逐项排查并尽快消除诱发因素。Objective To explore the clinical characteristics and therapeutic strategies for delirium in patients of general hospital during their hospitalization. Methods Among patients needing neurological consultation during January to June 2013,patients with delirium were selected according to the criteria of DSM- Ⅳ,and they were compared with those patients without delirium. Results There were 54 patients with delirium,12. 16% of them needed neurological consultation. Their average age of delirium patients was higher than that of non- delirium patients（ 73. 70 vs. 64. 45,t = 4. 193,P〈 0. 05）,but same in gender radio（ 32∶ 22 vs. 218∶ 172,χ^2= 0. 218,P 〉0. 05）. Patients with delirium chiefly came from surgical departments and ICU,they were more numerous than those in internal medicine departments（ 62. 96% vs. 25. 6%,χ^2= 31. 355,P〈 0. 05）. The most common inducing factors included metabolic disorders（ electrolyte disturbance and acute liver or kidney dysfunction）,hypoxemia and severe infections,postoperative pain was also common in surgical departments; 57. 63% of patients with delirium had more than 1 inducing factor. The clinical manifestations concentrated on decreased attention,psychomotor agitation,sleep cycle disorder,disorientation,delusion or hallucination and memory decline,more serious in nighttime. Most patients were spontaneously recovered after strengthened treatment of primary diseases and correction of inducing factors. Only 7 patients needed short course treatment and they were treated with small dosage of antipsychotic drugs. Conclusion In general hospital,elderly patients are more susceptible to delirium. Once the delirium occurred,the comprehensive treatment is advocated to identify item by item,and to eliminate the inducing factors as soon as possible.

关 键 词：住院患者 谵妄 临床特点 

分 类 号：R197.3[医药卫生—卫生事业管理]