Factors involved in the postoperative occurrence of mental disorders in patients with esophagus cancer

食道癌手術を受ける患者の術後精神症状の出現にかかわる要因とその関連性を明らかにする目的で、手術後ICUに入室した食道癌患者を対象に、生活背景、病状経過、生体機能変化、身体的苦痛、心理、サポートシステム、睡眠状況に関する91項目について診療記録および看護記録より調査を行った。術後精神症状出現群と非出現群との比較により、手術目的、ICU入室日数、気管内挿管日数、人工呼吸器装着日数、排液ドレーン留置日数、術後の血糖値の変化、ICUにおける個別の看護ケア計画、術後の夜間覚醒、術後の入眠処置（以上P＜0.01）、喫煙歴、病名告知、再建臓器、術後の血圧変動、術後のpH値･PO(2)値・PCO(2)値の変動、術後の病気に対する不安の訴え（以上P＜0.05）の有意な17要因が明らかになった。さらに要因間の関連分析により、精神症状の出現には手術侵襲による生体機能変化と術後の呼吸管理による身体的・精神的苦痛が大きな影響を及ぼしていることが明らかになった。出現予防のための看護は、術前・術後をとおしての患者の身体的・心理的状況の把握とICU環境からの早期離脱が重要であることが考えられる。To identify factors involved in the postoperative occurrence of mental disorders in patients with esophagus cancer and their relationship, 91 items about life background, disease course, changes in organic functions, physical pain, psychological conditions, support system, and sleep conditions were examined in patients with esophagus cancer treated at the ICU after operation using their medical and nursing records. Comparisons of patients with and without postoperative mental disorders revealed the following 17 factors that had significant influences on the mental conditions of patients : the aim of operation, period of treatment in the ICU, period of intratracheal intubation, period of artificial respiration, period of indwelling of a drainage tube, changes in blood sugar after operation, individual nursing care plan in the ICU, observation during the night after operation, and treatment for sleeping after operation (these parameters, p<0.01), and the history of smoking, notification of disease conditions, reconstructed organs, changes in blood pressure after operation, changes in pH, PO(2), and PCO(2) after operation, and anxiety about disease conditions after operation (these parameters, P