体外循环心脏术后并发精神障碍65例临床分析

目的　提高对体外循环心脏手术后并发精神障碍的认知与防治。方法　分析体外循环心脏手术后出现精神运动性障碍和情感障碍的病人的临床表现和转归。结果　本组并发精神障碍的发生率为 3 .2 5 % (65/ 2 0 0 0 ) ,61例病人精神障碍治愈 ,2例有阳性精神病家族史的患者好转出院 ,2例死亡。结论　体外循环中脑血流灌注不足 ,术后并发心、脑、肺、肾功能障碍及感染是病人出现精神障碍的主要原因。对于有阳性精神病家族史的病人 ,手术创伤可能是精神障碍的诱发因素。及时治疗躯体疾病及心理治疗 ,病人大多可获治愈。     

脑损伤所致精神障碍的相关因素分析

目的 对脑损伤所致精神障碍的相关因素进行分析.方法 以我院2011-2012年收治的198例脑损伤患者为研究对象.所有患者在治疗结束根据人格障碍筛查工具（PDQC）和人格障碍临床定式检查工具（SCICP）评估结果对其精神障碍进行诊断和分类,并对相关因素进行统计学分析.结果 198例脑损伤患者中并发精神障碍147例（74.24%）,其中初中以下文化水平患者76例,并发63例（82.89%）,初中文化患者79例,并发51例（64.56%）,高中及以上文化患者56例,并发23例（41.07%）,差异有统计学意义（P＜0.05）;中度及以上损伤程度患者108例,并发91例（84.26%）;脑挫裂伤患者165例,并发127例（76.97%）,差异有统计学意义（P＜0.05）;合并硬膜下血肿、颅内血肿、急性期精神障碍并发精神障碍患者分别为37例（86.05%）、93例（78.81%）、50例（94.34%）,分别与无相关并发症仍旧并发精神障碍患者109例（70.32%）、53例（66.25%）、97例（66.90%）相比,差异有统计学意义（P＜0.05）.结论 脑损伤后并发精神障碍与患者自身文化水平、脑损伤程度、性质、部位以及是否并发硬膜下血肿、颅内血肿和急性期精神障碍有关,对临床脑损伤患者预后判断有一定的指导作用.     

重型颅脑损伤后并发精神障碍临床分析

目的回顾分析重症颅脑损伤后并发精神障碍。方法总结我院1998-10~2006-10收治的重症颅脑损伤后并发精神障碍46例病人,分析伤情、受伤部位与并发的精神障碍间的关系。结果本组病人共出现4型精神障碍:躁狂型、抑郁型、精神分裂样型、痴呆型。损伤部位分别为:额叶损伤、颞叶损伤、胼胝体损伤、脑干损伤。损伤类型为:脑挫伤、弥漫性轴索损伤(DAI)、脑挫伤并发颅内血肿或并发脑疝。结论额叶脑挫伤或颞叶脑挫伤并发躁狂型精神障碍最多见,脑干损伤及DAI常出现痴呆型精神障碍。     

冠脉旁路移植术后并发精神障碍临床分析

目的探讨冠脉旁路移植术后并发精神障碍的高危因素。方法回顾性分析634例行冠脉旁路移植术患者资料,分析术后并发精神障碍者的危险因素、临床表现、预后及原因。结果冠脉旁路移植术死亡9例,并发精神障碍的发生率为15.14%(96/634),余均痊愈出院。同期心脏外科手术共4 429例,术后精神障碍共337例,发生率为7.61%(337/4 429)。冠心病组精神障碍发生率高于总体发生率,差异有统计学意义(u=15.41,P0.01)。结论合并颈动脉狭窄、术中的脑部低灌注、常温下的内环境紊乱等是冠脉旁路移植术后并发精神障碍特有的高危因素。冠脉旁路移植术前正确评估脑血管风险,避免或减少高危因素。     

老年髋部骨折复位术后并发精神障碍的影响因素分析及护理对策

目的分析接受髋部骨折术的老年患者发生精神障碍的影响因素以及相应的护理对策。方法选取2014年1月至2015年12月在我院行老年髋部骨折复位术的老年患者50例作为研究对象,根据患者是否在术后并发精神障碍分为精神障碍组(n=21)和无精神障碍组(n=29),对比分析两组患者的基本资料及躯体疾病种类等因素,采用Logistic回归分析各因素与发生精神障碍之间的相关性。结果单因素分析结果表明,精神障碍组患者的年龄显著高于无精神障碍组(P0.05),精神障碍组患者的血钠水平显著低于无精神障碍组(P0.05),精神障碍组患者并发慢性阻塞性肺疾病和进行全身麻醉的比例显著高于无精神障碍组(P0.05),Logistic回归分析表明年龄、高血钠、并发慢性阻塞性肺疾病、全身麻醉是发生精神障碍的危险因素(P0.05)。结论年龄、高血钠、并发慢性阻塞性肺疾病、全身麻醉可能是发生精神障碍的危险因素,需要根据患者的临床特点采取针对性的护理干预,以促进患者的康复。     

有机磷中毒后迟发性精神障碍26例临床分析

目的 提高对有机磷中毒后并发精神障碍的认知与防治。方法 分析有机磷中毒后出现精神障碍的病人临床表现 及转归。结果 本组并发精神障碍的发生率为9.77％(26/266)其发生机制不十分清楚,很可能是多种因素综合的结果。结论 及时治疗原发病及其并发症,迟发精神障碍后及时发现并应用抗精神病药物及心理治疗,病人大多可治愈。     

体外循环心脏术后并发精神障碍的临床分析

目的探讨对体外循环(CPB)心脏术后并发精神障碍的可能原因和防治方法。方法回顾性分析我院2010-01～2010-12施行的1 128例体外循环心脏术后并发精神障碍45例的临床资料和防治措施。结果除2例因多脏器衰竭而死亡,其余均经治疗1～2周内康复而出院。随访1～3个月均未再出现精神障碍表现。结论体外循环心内直视手术后发生精神障碍是包括体外循环、生理功能、环境、心理等多因素共同作用的结果,应采取综合防治措施。     

有机磷中毒后迟发性精神障碍26例临床分析

目的 提高对有机磷中毒后并发精神障碍的认知与防治。方法 分析有机磷中毒后出现精神障碍的病人临床表现及转归。结果 本组并发精神障碍的发生率为9．77％(26／266)其发生机制不十分清楚，很可能是多种因素综合的结果。结论 及时治疗原发病及其并发症，迟发精神障碍后及时发现并应用抗精神病药物及心理治疗，病人大多可治愈。     

造血干细胞移植患者隔离期间精神科联络会诊分析

目的:探讨行造血干细胞移植患者隔离期间精神科联络会诊特点。方法:回顾性分析2014年至2016年行造血干细胞移植且在隔离期间并发精神障碍邀请精神科会诊的111例患者的一般资料及临床资料。结果:共有1 523例患者(男839例,女684例)行造血干细胞移植,111患者(7.3%)入住净化舱隔离期间并发精神障碍而邀请精神科会诊;女性患者并发精神障碍的比率(9.1%,62例,)明显多于男性(5.8%,49例)(χ~2=5.796,P0.05);2014年至2016年精神科每年会诊率(6.2%、6.6%及8.6%)比较差异无统计学意义;精神科会诊诊断依次为焦虑状态31例(30.0%)、抑郁状态29例(26.1%)、应激相关障碍14例(12.6%)、躯体疾病所致精神障碍13例(11.7%)、睡眠障碍9例(8.1%)、焦虑及抑郁状态9例(8.1%)、药物所致精神障碍2例(1.8%)、其他4例(3.6%);其中82例(73.9%)建议给予药物治疗或药物联合心理治疗。结论:造血干细胞移植隔离期间患者、尤其是女性患者并发各种精神障碍的比率很高,多半为情绪障碍。     

人工关节置换术后并发精神障碍的临床分析

人工关节置换术后常有精神障碍现象发生,我们回顾性总结行人工髋、膝关节置换术的患者113例,初步探讨人工关节置换术后并发精神障碍的相关因素和防治措施. 对象为2007年1月至2009年4月在我院骨科行人工髋、膝关节置换术患者.     

心脏手术后精神障碍的临床分析

为研究心脏手术后精神障碍的病因、发病机理及防治措施，对２０５３例心脏手术病人进行了观察。结果显示，５４例病人出现精神障碍并发症，发生率为２．６３％；其中体外循环术后发生率为３．１２％，非体外循环术后发生率为１．４７％，两者间差异有显著性（Ｐ＜０．０５）。术前心功能状况较差者，更易出现精神障碍（Ｐ＜０．０１）。病人均为成年人，症状大多出现于２周以内，表现为躁狂状态、抑郁状态、精神分裂样状态及神经症性反应，经治疗后均痊愈。认为心脏术后精神障碍主要与精神因素、体外循环损伤、心功能状况、年龄等有关，强调精神因素所起的作用，提示应采取综合治疗及预防。     

神经内镜下经鼻蝶手术切除垂体瘤术后并发症探讨分析

目的总结神经内镜下经鼻蝶手术切除垂体瘤术后并发症的发生原因、治疗和预防方法。方法回顾性分析由同一术者完成的61例神经内镜下经鼻蝶手术切除垂体瘤的临床资料,并对术后并发症进行分析。结果肿瘤全切除41例,次全切除20例。24例侵袭海绵窦中,肿瘤全切除12例,次全切除12例。平均手术时间70min。术后视力下降均有所改善;38例功能性垂体腺瘤中．激素水平下降33例;头痛缓解22例。并发症情况：暂时性尿崩症6例,低钠血症6例,脑脊液漏6例,颅内感染1例,垂体功能降低3例,术区血肿1例,蝶窦炎症3例;经对症处理后,均痊愈或改善。结论内镜手术创伤小、术后并发症少,术前周密的手术计划和风险评估,了解垂体瘤生长特点,及术后严密观察可减少术后并发症、缩短住院时间。     

神经内镜手术并发症分析

目的 对神经内镜手术并发症进行分析探讨.方法 对49例病人的术后反应及并发症的发生原因、预防及治疗方法进行分析。结果 49例术后反应及并发症病人经治疗后均恢复。结论 神经内镜手术属微创治疗方法，并发症多不严重，且不多是可以预防的。     

Effect of open heart surgery on intellectual performance

Abstract

The interrelationship between postoperative psychosis, neurologic symptoms, and changes in tests of cognitive performance have been studied in a series of 60 cardiac valvular patients who underwent open heart surgery. The effects of preoperative psychological, psychiatric, and cardiologic factors on postoperative cognitive changes were analyzed. The investigation period was from five months before up to five months after the operation. There was a general trend towards improvement in intellectual performances. The psychotic group, however, still showed a persisting impairment in some visual and psychomotor tests several months after the surgery. The group with neurologic symptoms showed impairment in one visual test. Of the preoperative variables, mitral valve disease, a high level of hypochondriasis and anxiety, and poor performance in some visual and psychomotor tests predicted postoperative intellectual impairment. The results suggest two types of cerebral complications of open heart surgery. Postoperative psychosis reflects diffuse brain dysfunction manifesting itself in psychological tests long after the clinical symptoms have resolved. The presence of neurologic symptoms refers to a focal or lateralized injury. Both the neurologic and neuropsychologic findings indicate that the right hemisphere may be more prone to dysfunction than the left hemisphere.     

巨大垂体腺瘤二次经蝶手术30例分析

目的探讨巨大垂体腺瘤二次经蝶手术策略、技巧及术后并发症处理方法。方法回顾性分析30例巨大垂体腺瘤二次经蝶手术病人的临床资料,对手术切除程度、术后症状、激素水平变化及并发症处理等进行总结和分析。结果术后病理结果显示：无功能性腺瘤22例,其中无功能性促肾上腺皮质激素腺瘤1例;生长激素腺瘤8例。功能性垂体腺瘤病人术后激素水平均不同程度下降。术后并发一过性尿崩症9例,脑脊液鼻漏4例,无死亡或严重并发症病例。术后3个月行MRI复查17例,肿瘤全切除4例,次全切除7例。部分切除6例。结论对单纯经蝶或经颅入路均无法一期全切除或术后随访肿瘤复发的巨大垂体腺瘤病例．二次经蝶手术应作为首选治疗方法。     

二次手术治疗难治性精神病的临床体会

目的探讨立体定向多靶点手术治疗难治性精神病失败的原因及二次手术的治疗效果。方法对23例已行立体定向手术治疗的效果欠佳的难治性精神病患者,分析原因,再次行立体定向多靶点组合毁损手术治疗。应用CGI、WISC、BPRS、PNSS精神病评定量表对治疗效果进行评定。结果 23例患者中,显著进步15例,进步5例,无变化3例。手术前后量表评分有显著差异(P<0.05)。无智商损害等严重并发症和后遗症发生。结论二次多靶点定向毁损治疗难治性精神病,仍效果显著。     

Association between severity of untreated sleep apnoea and postoperative complications following major cardiac surgery: a prospective observational cohort study

ObjectiveTo examine whether untreated sleep apnoea is associated with prolonged Intensive Care Unit (ICU) stay and increased frequency of postoperative ICU complications, in patients undergoing major cardiac surgery.Patients/methodsAdult patients, undergoing elective coronary artery bypass grafting with or without cardiac valve surgery, between March 2013 and July 2014, were considered. We excluded patients participating in other interventional studies, those who had a tracheostomy before surgery, required emergency surgery or were due to be admitted on the day of surgery. Patients underwent inpatient overnight oximetry on the night prior to their surgery to assess for the presence of sleep apnoea. Since oximetry alone cannot differentiate obstructive from central apnoea, the results are reported as sleep apnoea which was diagnosed in patients with an arterial oxygen desaturation index (ODI) ≥ 5/h.ResultsThe primary outcome measure was length of stay (LoS) in ICU in days. The secondary outcome was a composite measure of postoperative complications in ICU. Multivariate models were developed to assess associations between ODI and the primary and secondary outcome measures, adjusting for preselected predictor variables, relative to primary and secondary outcomes. There was no significant association between ODI and ICU LoS, HR 1.0, 95% CI 0.99–1.02; p = 0.12. However we did find a significant association between ODI and postoperative complications in the ICU, OR = 1.1; 95% CI 1.02–1.17; p = 0.014. The probability of developing complications rose with higher ODI, reflecting sleep apnoea severity.ConclusionsAcknowledging the limitations of this prospective study, untreated sleep apnoea did not predict an increased length of stay in ICU but we do report an association with postoperative complications in patients undergoing major cardiac surgery.     

Analogical reasoning and postoperative outcome. Predictions for patients scheduled for open heart surgery.

We investigated whether postoperative outcome of open heart surgery is related to preoperative cognitive dysfunction. Patients ill enough to require open heart surgery frequently have gravely compromised circulation and, hence, possible brain damage. The Conceptual Level Analogy Test (CLAT), a new, rigorously constructed analogy test, was used to measure cognitive dysfunction. The results indicated that the CLAT, aministered preoperatively to open heart surgery patients, differentiated between patients having different types of postoperative outcome. A significant relationship between type of surgical procedure and poor postoperative outcome was also found; cardiac valvular surgery patients had significantly worse outcome than coronary bypass surgery patients. The incidence of good outcome (survival with no psychiatric complications) was 28% for cardiac valvular surgery patients with extremely poor preoperative CLAT scores, but 74% for valvular surgery patients with higher preoperative CLAT scores.     

Psychiatric effects of cardiac surgery]

The authors report three cases of psychotic complications of cardiac surgery. A review is made from literature and an inventory of psychological and organic factors implicated in this pathology. These complications are still frequent (up to 50% for Braceland, and 70% for Rabiner and al.). For Blacher there is an almost universal "psychosis" in by-pass surgery and frequent "hidden psychosis" (they are ignored and denied both by the staff and the patient). They are caused by the emotional stress, intensive care unit syndrome, or personal vulnerability. The symbolism of the heart and the personality of the cardiac patient are also in cause. Neurologic accidents, hypoxy, embolisms, are now less frequent. The collaboration of a psychiatrist with the cardiologic staff is mandatory. With this collaboration not only psychiatric complications but also somatic morbidity and mortality would be reduced.     

加速康复外科在经鼻蝶手术治疗垂体腺瘤中的应用

目的探讨加速康复外科(FTS)在垂体瘤经鼻蝶手术患者围手术期的应用价值,提出初步的临床治疗路径。方法回顾性分析我科自2009年1月至2012年1月经手术和病理证实为垂体瘤并入选研究的患者189例,均接受经鼻蝶入路垂体瘤切除术,其中82例患者采用加速康复外科临床路径作为研究组,其余107例患者采用传统临床路径作为对照组。随访至术后3个月,采用临床对照研究,比较两组患者术前准备时间、肿瘤切除率、术后住院时间、术中脑脊液漏、术后主要并发症发生率及总住院时间。结果加速康复外科组较传统组术前准备时间、术后住院时间及总住院时间明显缩短,术中脑脊液漏及术后脑脊液漏发生率明显减少,而肿瘤切除率、术后尿崩发生率无显著性差异。结论加速康复外科治疗理念更利于接受经鼻蝶手术的垂体瘤患者的治疗。