術後せん妄の発症状況とそれに対する看護ケアについての臨床的研究

Abstract

In this study, we analyzed the onset situation of postoperative delirium, which was a serious problem in nursing care, in relation to preoperative state, surgical stresses, postoperative environment. We also investigated the care of nursing for it. Symptoms of postoperative delirium were observed in 17 out of 164 patients who underwent operation in Kyoto University Hospital from July to September in 1999. Male aged patients tended to show postoperative delirium. The past history of cerebral vascular disorders, the duration of operation more than 6 hours and the postoperative care in intensive care unit were also statistically significant factors contributing to the onset of postoperative delirium. Sleeplessness, disorientation, hyperkinesis, verbosity, and retarded and improper reply were the most frequent symptoms. Pulling out venous line and raising a queer cry were seen in more than half of the symptomatic cases and these symptoms appeared mainly at night, indicating the contribution of disorder of sleep-awake rhythm to postoperative delirium. As care for postoperative delirium positive communication, exercise stimulation, and environment preparation were done. These nursing cares seemed to be effective through normalizing sleep-awakening rhythm. Although medication was effective for normalizing sleep-awake rhythm and avoiding various dangers of delirious patients, the direct effect of medication to delirium was obscure. Because prediction of onset of postoperative delirium was possible in some extent from age, past history, and the way of postoperative management, it is necessary to establish an appropriate approach to high-risk patients of postoperative delirium and systematic nursing care for delirious patients.