Postoperative acute mental disorder
Introduction
Introduction Refers to postoperative brain dysfunction in elderly patients without mental abnormalities before surgery, mainly in the sense of disturbance of consciousness, cognitive impairment and psychomotor abnormalities, often occurred in the first 4 days after surgery, easy to attack at night, with light morning light specialty.
Cause
Cause
1. Patients' own factors: It is generally believed that patients with emotional instability and sentimentality are prone to postoperative acute mental disorders.
2. Surgical factors: The incidence of postoperative acute mental disorders in open heart surgery under cardiopulmonary bypass is much higher than other operations, mainly due to cerebral embolism or hypoperfusion of the brain caused by extracorporeal circulation. In addition, the incidence of mental disorders after neurosurgery, traumatic chest and abdomen surgery, and hip replacement surgery is also higher.
3. Anesthetic factors: It is currently considered that there is no significant correlation between anesthesia and postoperative mental disorders. However, the extremely low concentration of certain anesthetic drugs may affect the nerve function. Anticholinergic drugs such as scopolamine may interfere with the storage process of information in the brain, leading to memory function damage; propofol slightly reduces the orientation and self-control ability. And understanding; ketamine has a specific inhibitory and excitatory dual effect on the central nervous system.
4. Perioperative management: intraoperative blood pressure fluctuations, hypoxemia, hyperventilation, blood loss or extreme blood dilution affect cerebral blood flow and brain oxygen supply, have direct or indirect effects on postoperative mental disorders. In addition, postoperative pain and changes in sleep cycle are also the cause of postoperative acute mental disorders.
Examine
an examination
Related inspection
Blood test EEG examination
Postoperative brain dysfunction occurs mainly in disturbances of consciousness, cognitive impairment, and psychomotor abnormalities.
Postoperative manifestations were indifferent mental reactions such as apathy, nightmares, hallucinations, and paralysis.
Diagnosis
Differential diagnosis
Differential diagnosis of postoperative acute mental disorders:
1, brain organic mental disorders: brain organic mental disorders (brain organic mental disorders) refers to mental disorders caused by brain infections, degeneration, vascular disease, trauma, tumors, etc., also known as brain organic psychosis (brain organic psychosis). With the extension of human life, the aging population is gradually increasing, and the incidence of brain organic mental disorders is also significantly increased.
2, organic mental disorder: organic mental disorder - based on verifiable brain disease, brain damage or other damage caused by a group of mental disorders. The mental disorder can be primary, such as directly and selectively affecting the brain's disease, injury, and damage; it can also be secondary, such as certain systemic diseases and disorders, the brain is just multiple damaged organs. Or one of the systems. The term symptomatic mental disorder refers to the latter subgroup. See: organic psychosis.
3. Mental disorders caused by psychoactive substances: Mental disorders associated with psychoactive substances (referred to as substances) can be divided into two categories: one is the use of psychoactive substances (substance dependence disorder and substance abuse), and the other is spirit. Obstacles caused by active substances, including: psychoactive substance poisoning, psychoactive substance withdrawal reaction, psychoactive substance-induced paralysis, persistent dementia caused by psychoactive substances, persistent amnesia caused by psychoactive substances, spirit Psychic disorders caused by active substances, mood disorders caused by psychoactive substances, anxiety disorders caused by psychoactive substances, sexual dysfunction caused by psychoactive substances, and sleep disorders caused by psychoactive substances.
4. Mental disorders caused by non-dependent substances: mental disorders caused by non-dependent substances (mental dsorders cused by nn-ependent sbstances), certain non-dependent substances such as hormones, isoniazid, benzene, organic phosphorus, etc. In vitro, although it does not produce psychological and physiological dependence, it can affect an individual's mental state and produce psychotic symptoms, which are often confused with schizophrenia.
5. Mental disorders caused by somatic diseases: Mental disorders caused by physical diseases refer to mental disorders manifested in the entire course of internal organs, endocrine, metabolism, nutrition, blood, collagen diseases and infections, and other medical diseases. It is more common to develop acute mental disorders based on primary physical diseases. It is an integral part of all the symptoms of the primary physical illness. Mental disorders caused by physical illness generally do not include mental disorders caused by psychoactive substances and brain organic disorders.
