??????????(postoperative acute confusional state)

1
????????????
?????????????
??? ??? ?? ???
2
???????,????????????,????2001?12379??????65???
?????26.3???????????????????????????????,????????
???,????????????????,?????????????????????????????
3
????????????
??????????(postoperative acute confusional
state) ????(postoperative delirium)
??????(postoperative cognitive dysfunction)
???????(postoperative acute brain failure)
?????????(postoperative organic brain syndrome)
???????(postoperative toxic psychosis)?
??????(postoperative mental state
changes)??????????????????????????????,???????????
????????????????????
4
?????
???? ???????()
?????? 46
?????? 7-77
?????? 50
????? 13-41
????? 7-17
???,??????????? ????????? 25-45 ???????? 19
5
??????????????SICU1999?11??2002?3?????65?????
??380?,??????????????????????????
6
?????
???? ??? P?
?? 0.2456 0.6202
?? 0.8315 0.3618
???? 0.5795 0.4465
???? 0.2226 0.6371
???? 0.3968 0.5288
???? 0.0783 0.7796
?????? 17.4254 0.0001
????? 4.9644 0.0259
????? 6.7109 0.0096
????????? 35.3916 0.0001
????? 0.2154 0.6426
7
?????? 1.??
AGE65????????????????????2-10??
Seymour?????, AGE75????????????????????65-75?????
3??
8
2.??????? ????,????????/????????????????????
?????????????????????,????????????,???????????????
???????????
9
3.?????? ????,????????????????????????????????
?????????????????????????????????????????????????
???????,????????????????
10
4.??????????? ????,???????????,??????????????
???,??????????????????
11
5.????? ?????????????,?????????????,???????,??
???????????-????,????,???????????????????????????,
?????????? ????????????????,???????????????????
???????(NO)???????????????,???????,?????????????,?
??????????
12
6.??????? ??????????????????????????PaCO2??
??????????? ???????????????????????????????
??????????
13
7.??????? ????????????????????????????????
????,?????????????Wilson??,?????????ICU???????2-6?
?
14
8.?? ????E(ApoE)???????????????????,????????
????,?????????????????????????????ApoE????????????
????????,?????(CCK)???????????????????
15
?????? ???,?????????????????????????,???????
?????????????????,???????????????????????????????
16

1. ?? ??????????

????? ?????????????,???????,??????,???????????
???
????? ??????????10-20,???????????????????,???
?????????,?CO2?????????????
?????? ????????????????,??????????????????????,?
????????
???? ??????????????,?DA?5-HT?Ach?GABA??
17
2.??? ??????????(NSE)?S-100ß??????????????????
?,??????,?????????NSE?S-100ß??????,???????????????
????????????????????????????
18
3. ??????????

5-HT?NE??????????????????????,??5-HT??????????
???
Ach????????????,?????????,?????Ach??????
???(Glu)?GABA?????????????????,??????????
19
4.???-??-????????????? ???????????-??-?????????
?????????,??????????????????????????(IL-1?IL-2?IL-
6?a-TNF)???,????Ach?5-HT?NE??????????,?T3????????
?????????????????
20
?????? ??????????????4???,???????????????
???????????????????,???????,????????,????,
70???????????? ??????,?????????
1. ??? ???????????,?????????,??????????
2. ??? ???????????????? 3. ???
????????????
21
???? 1.???????????
?????????????????,???????????????,????????????????
???????????????????,????????(Confusion Assessment
Method,CAM)???DSM-?-R??,??????????????????????ICU
???????,?ICU???????(CAM-ICU)?ICU???????(The
Intensive Care Delirium Screening Checklist)??
22
2. CT?EEG?? (1) CT?????,???????????????????? (2
) EEG?????????????????????????,???a??,????????????
???????s??????????????????,??,????EEG????
23
3. ????? ????,?????????,???,??????,?????,?
?????????,??????,????????????????????
24
???? 1. ???????(??????)? 2.
??????????????? 3. ?????????????????????????
4. ???????????????????? ???????????????
??????????????
25
???? 1.????? ??????????????????????????????????
??? 2.???? ????????????????,????????????????????
??????? 3. ???? ?????????,????????????
26
????,????????????????,?????????,????????????
?,????????????,??,????????????????????????????????
??????,???????????????????????????????????????,???
?????????????????,?????????????????,????????????,?
??????????????????,????????????????,?????????,????
????????,???????????,??????,???????????
27
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