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術後の妄想:手術後の妄想を患った76歳の女性
1Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts 02215, USA. emarcant@bidmc.harvard.edu
JAMA
|June 7, 2012
まとめ
高齢者の一般的な合併症である術後妄想は,しばしば臨床医によって見逃されますが,予防および治療は可能です. リスク要因を標的とした,積極的な,多要素的介入は,この状態の管理の鍵です.
科学分野:
- ゲリアトリック・メディシン (老年医学)
- アネステシオロジー アネステシオロジー
- クリティカルケア・メディシン
背景:
- デリリウム (急性混乱) は,大きな手術を受ける高齢者の15%から50%に影響します.
- それは,長期の入院,機能的低下,および死亡率の増加などの有害な結果に関連しています.
- その流行と影響にもかかわらず,手術後の妄想はしばしば認識されず,治療されていません.
研究 の 目的:
- 術後の妄想症の診断,予防,治療をレビューする.
- 高齢の外科患者の妄想管理における積極的な介入の重要性を強調する.
- これらの概念を臨床事例の例を使って説明します.
主な方法:
- 術後の妄想症の診断,リスク要因,および管理戦略に関する文献のレビュー.
- 手術後の妄想を経験した76歳の女性患者のケーススタディのプレゼンテーション.
- 誘発要因と誘発要因を標的とした多要素介入の議論.
主要な成果:
- 術後の妄想症のリスクは,予備要因と原因要因の合計によって定量化されます.
- 効果的な予防と治療には,主動的で多要素的な介入が必要です.
- 鍵となる戦略は,鎮静剤の制限,痛みの管理,および抗精神病薬の潜在的使用です.
結論:
- 妄想は,高齢の外科患者の重要な,しばしば予防可能な合併症です.
- 早期の認識と標的の介入は,結果を改善するために極めて重要です.
- 修正可能な危険因子に対処する包括的なアプローチは,手術後の妄想の管理に不可欠です.
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