Psychiatric disorders associated with perioperative period
Introduction
Introduction to mental disorders associated with perioperative period Surgery is a serious psychological stress for patients. Pre- and post-operative patients generally have psychological stress, anxiety, depression, fear and other stress reactions. Postoperative mental disorders are not independent disease units, including psychogenic reactions, induced by endogenous psychosis, but mostly symptomatic mental disorders. Post-surgical mental disorders refer to mental disorders that occur within a few days after surgery. basic knowledge The proportion of the disease: the incidence rate in the surgical population is about 0.5% - 0.7% Susceptible people: no special people Mode of infection: non-infectious Complications: high blood pressure, headache, neurological headache, sleep disorders, hypertensive encephalopathy
Cause
Causes of mental disorders associated with perioperative period
Psychological factors (30%):
Mainly due to fear of surgery, worry, patients are generally afraid of surgery before surgery, fear of anesthesia accident, fear of headache, fear of bleeding, fear of disability, fear of death, etc., these bad mentality is mostly because of the lack of understanding of the surgical situation; It is related to individual personality (sensitive, suspicious), physical fitness, and tolerance; age (highest middle-aged), culture (higher culture, more severe anxiety), size of surgery, severity of disease, etc. There are also varying degrees of influence.
Physical factors (25%):
Due to postoperative weakness, blood loss, shock, organ damage, various metabolic disorders including water, electrolyte imbalance, sugar, protein abnormalities, anesthesia, co-infection and endocrine abnormalities affect brain function.
(two) pathogenesis
May be related to the following factors:
1. Changes in the body condition after surgery, such as fatigue, exhaustion, imbalance of water and electrolyte balance, endocrine disorders and so on.
2. The effects of surgical procedures and anesthetics on brain function.
3. Surgical complications, such as brain damage, infection, fever, respiratory insufficiency, etc.
4. Environmental and psychological factors after surgery, such as postoperative ICU, environmental stimulation, isolation and sensory blockage, such as the limitations of various examination instruments in the ICU, difficulty in physical movement, oxygen mask, etc., easy to enter the patient status.
5. The psychological stress and individual factors of patients before and after surgery, such as the patient's gender, age, culture, occupation, personality characteristics, as well as the location and complexity of surgery are related to the occurrence of mental disorders.
Prevention
Perioperative prevention of mental disorders
Patients should be psychologically counseled before and after surgery. Targeted guidance should be given, supplemented by comfort, support and counseling to eliminate their nervousness. If possible, patients and their families can visit the operating room and ICU before surgery. In the ICU, Separate from other critically ill patients as much as possible to avoid seeing the treatment of patients with adjacent beds and sudden death, which will contribute to perioperative mental disorders.
Complication
Perioperative complications associated with mental disorders Complications, high blood pressure, headache, neurological headache, sleep disorders, hypertensive encephalopathy
The disease usually causes high blood pressure due to excessive stress, anxiety, fear and other factors, which affects the surgical process. At the same time, due to fear of surgery, patients may also have mental headaches and mental sleep disorders. It can even induce hypertensive encephalopathy, so clinicians should pay attention to such problems, and actively give spiritual guidance to inform them of the necessity of surgery and the safety of surgery.
Symptom
Symptoms of mental disorders associated with perioperative period Common symptoms Sleep disorder Postoperative acute mental disorder Thinking rupture Frustration illusion Speech increase Unreliable anxiety
Postoperative mental disorders can be divided into acute phase disorders and chronic phase disorders. Most of the acute phase disorders occur 2 to 5 days after surgery. The symptoms of sputum and schizophrenic symptoms are more common. Some patients may present depression and anxiety. Status, such as low mood, reduced interest, sleep disorders, restlessness, disease duration of about 1 to 3 weeks, the majority of the original mental illness recurrence, chronic phase disorders are more common with neurosis-like or chronic cerebral debilitating symptoms, often secondary to Brain organic damage, the majority of patients with chronic organic mental disorders, such as personality changes, mental decline and brain weakness, etc., the symptoms of mental symptoms and surgery types and anesthesia methods have nothing to do, patients entering the ICU due to serious illness, the body has In stress, poor environment, invasive examination, mechanical ventilation, etc., causing psychological stress, anxiety, tension, fear, depression, pain and discomfort, and abnormal sleep. 9 cases of post-operative mental disorders have been reported. The patient had symptoms of psychiatric symptoms, 8 patients were treated 2 to 10 days after surgery, and 1 patient was treated 4 weeks after surgery. Symptom duration, short 6 days, maximum 45 days, most of them 1 4 to 30 days; its clinical features, 9 cases are schizophrenic-like symptom groups, showing excitement and agitation, fear of nervousness, increased speech, behavioral disorders, broken thinking, suspicion, hearing and visual hallucinations, clinically common Mental disorders before and after surgery.
1. Psychological disorders and mental illness after sterilization
This is more common in rural family planning. According to recent statistics, the psychological and psychological diseases in the complications of birth control surgery in China account for 60% to 70%. The clinical manifestations include the following aspects: anxiety, pessimistic depression, thinking Slow, unresponsive, general weakness, sexual dysfunction, suspicion and paralysis, especially postoperative neurosis (about 50% to 60%), neurasthenia, snoring, obsessive-compulsive disorder, chronic functional pain, etc. The onset is related to various psychological factors and psychological states before surgery, such as passive attitude towards sterilization surgery; poor mental state before surgery; fear of surgery, tension; personality characteristics, mostly emotional instability, more suggestive ; low level of education; society, family pressure, etc., the key to this disease is prevention, vigorously carry out psychological counseling and counseling before surgery (including the family members and relatives of the parties), Liu Biaozi (1997) in "Women's sterilization The prospective study of psychosomatic response indicates that the preoperative risk factors are attitudes toward sterilization, hostility, high suggestiveness, emotional instability, low pain threshold, etc. People are preoperative, intraoperative special focus on the target, after giving appropriate psychological support, counseling and anti-anxiety and other comprehensive treatment, after one year of postoperative follow-up effect is remarkable.
2. Psychological disorders after hysterectomy
Hysterectomy has increased in recent years. Psychological disorders appear before and after surgery are not uncommon. There are 9 cases (20.5%) with anxiety in 8 cases, and 8 cases (18.2%) with depression. Uterine resection plus The upper ovarian resection, the incidence of anxiety is 61.5%, the reason may be related to some women worried that removal of the uterus will change women's gender, identity, sexual dysfunction and disappearance, reduce women's charm, affect sexual life, affect husband and wife relationship Etc., these constitute psychological stress. In addition, after comparing the follicle stimulating hormone and luteinizing hormone in the ovariectomized group, it is found that there are significant differences between the two groups, indicating that oophorectomy affects gonadal function. People have certain influence on mental activities, so they should be cautious about hysterectomy and try to keep them. For patients with high-risk mental disorders, psychotherapy and hormone replacement therapy should be performed before and after perioperative.
3. Psychological disorders after kidney transplantation
Today, with the rapid development of modern medicine, kidney transplantation has become one of the important treatment measures to save the lives of countless uremic patients. In China, 15976 cases have been accumulated by the end of 1995. With the continuous increase in the number and quality of kidney transplants, kidney transplantation The life and quality of life have attracted people's attention. The most common problem is sexual psychological disorder. Zheng Junhua (1996) conducted a sexual psychological investigation on 220 kidney transplanters and their families who survived for more than 3 years and found that in the early stage of kidney transplantation. 96% of people have fears about sexual life, anxiety, fear of impairing kidney function, leading to kidney rejection, unable to meet each other's sexual requirements and unable to complete sexual life, even after 1 year of kidney transplantation, there are already sexual life experiences. This concern still exists. According to the survey, the post-marital relationship is as good as 29.5%, which is worse than the pre-operative 70.5%, including extramarital affairs and divorce. As early as 1978, Lim pointed out that successful kidney transplantation can make kidney function. Restoring normal and regaining sexual and fertility, it is better than hemodialysis to improve the quality of life of patients with chronic renal failure, the above heart The psychological barriers, psychological counseling, relaxation training, etc. can be completely relieved. The changes of pituitary-sex hormones and serum trace elements in patients after kidney transplantation occur within about 3 months after surgery, so early sexual life should not be frequent. Due to the slow recovery of serum zinc content, high-zinc kelcon can be given, and patients should be confused, frustrated, anxious, feared and other social aspects of sexual behavior, and families should be given understanding, support and help.
Examine
Perioperative examination of mental disorders
The disease belongs to mental disorders caused by mental anxiety and tension. Because the disease needs to be differentiated from organic brain lesions, it is necessary to perform head CT and MRI examinations. If necessary, cerebrospinal fluid examination is needed to determine whether there is any There is an intracranial infection. Psychological counseling and examination, as well as psychological counseling, can clearly identify the starting mental factors of the disease. At the same time, routine examinations such as blood routine, liver and kidney function, and EEG are required.
Diagnosis
Diagnosis and diagnosis of mental disorders associated with perioperative period
The diagnosis of mental disorders associated with perioperative (before and after surgery) is easy. First, there must be a clear history of surgery, and the occurrence of mental symptoms is highly correlated with surgery.
1. Symptoms appear 2 to 10 days after surgery.
2. There is no history of mental illness before surgery.
3. Symptoms are usually relieved quickly after treatment.
It should be differentiated from other physical illness-induced mental disorders and functional psychosis such as schizophrenia and affective disorders.
