酒精依赖对老年颌面外科手术患者围术期谵妄的影响

目的 比较酒精依赖和非酒精依赖行颌面外科手术老年患者术后谵妄的发生率.方法 颌面外科手术患者60例,年龄60～80岁,性别男,ASA分级Ⅰ～Ⅱ级,手术时间4～6 h,符合酒精依赖条件的为酒精依赖组(AD),无酒精依赖患者组成非酒精依赖组(NAD),每组患者各30例,记录麻醉药(芬太尼、瑞芬太尼和丙泊酚)用药量;手术时间和苏醒(RE90)时间、拔管时间.术后评估患者VAS评分,以及是否出现苏醒期谵妄,并用ICU意识模糊评估法(CAM-ICU)连续一周评估两组患者是否发生谵妄(CAM-ICU),并记录术后谵妄的病例数.结果 两组患者在年龄,ASA分级,手术麻醉时间,苏醒时间,拔管时间上均无差异(P＞0.05);麻醉药用量,酒精依赖组(AD)高于非酒精依赖组(NAD),不过没有统计学意义(P＞0.05);酒精依赖组(AD)在苏醒期谵妄(10％)和术后谵妄的发生率(60％)均高于非酒精依赖组(NAD)的苏醒期谵妄发生率(3％)和术后谵妄发生率(27％)(P＜0.05).结论 酒精依赖会明显增加老年颌面外科手术患者围术期谵妄的发生率.

The effect of alcohol dependence history on the incidence rate of postoperative delirium in old patients

Objective To evaluate the effect of alcohol dependence history on the incidence of postoperative delirium in old patients after Maxillofacial surgery.Methods Sixty male patients who were underwent undergoing worked very hard to bu assigned to axillofacial surgery,aged 60-80 years of ASA and grade Ⅰ or Ⅱ were selected,and 30 cases with alcohol dependence history as alcohol group (group AD),30 cases without alcohol dependence history as non-alcohol dependence group (group NAD).The dose of general anesthetics (fentanyl,propofol and remifentanil),operation time,waking time and extubation time (RE90),VAS score after surgery of the two groups were recorded.The CAM-ICU was performed to assess the cognitive function when patients were awake and fiom the 1 st to 7th day after surgery,then the incidence rate of postoperative delirium was compared between the two groups.Results There was no statistical significant difference in general anesthetics consumption,operation time,waking time and extubation time between the two groups.The incidence rate of delirium during waking time and postoperative delirium in the period of group AD (alcohol dependence)was significantly higher than that in group NAD(P ＜ 0.05).Conclusion The incidence rate of delirium in waking time and postoperative period are increased in patients with alcohol dependence history after maxillofacial surgery.