Study on the delirium-inducing factors after operation in aged surgical patient

The purpose of this study was to extract the factors of delirium after operation (DAO) and to consider nursing practice which prevented DAO. Fourty eight patients over 65 years old agreed to participate were enrolled. We measured physical and psychological postoper ative state with the Japanese version of the NEECHAM Confusion Scale(J-NCS), and collected information about DAO, such as clinical and laboratory date. Among 48 patients, only 2(4%) patients developed DAO. Twenty five patients were classified as high risk group, and the remaining 21 patients were classified as normal group. Comparing the high risk group with normal group, l)invasive surgical procedure, 2) postoperative anemic state, and 3)being on a drip or drainage were extracted as risk factors. About the nursing practice for high risk group, a)pain control b)observation of behavior, and c)aids for sleeping were ranked. The reason why such low rate (4%) of DAO in this study could be speculated that the preoperative orientation of DAO exhibited preventive effect for the patients, and this was suggested that informed consent about DAO before surgery might be effective for prevention of DAO.本研究は,高齢手術患者のせん妄発症要因を明らかにすること,せん妄予防につながる看護を考察することを目的に行った.術前から術後5日目まで,日本語版ニーチャム混乱・錯乱スケールを用いてせん妄の測定反び,せん妄に関連すると考えられる因子について調査した.結果,対象48名中2名がせん妄を発症し,25名がせん妄高リスク群,21名が正常群であった.せん妄高リスク群と正常群の比較では,(1)手術侵襲が大きい(2)術後貧血状態にある(3)ドレーン・ルート類が多く挿入されている,の3要因が抽出された.せん妄高リスク群(せん妄を起こす危険は高かったが発症には至らなかった群)に実施されていた看護内容は,「術後疼痛の緩和」「行動の注意・観察」「睡眠の促し」が上位を占めた.また,今回せん妄発症率が4%と低かったことに関し考察を行った結果,患者が術前にせん妄についての知識を得たことが,せん妄予防に有効だったのではないかと考えられた