STUDY OF ETIOLOGY AND TREATMENT ON DELIRIUM

转诊至库尔斯克大学医院咨询联络处（CLS）的患者最常见的诊断是谵妄。这种增加的原因包括谵妄患者的数量可能是由于住院的老年患者数量增加以及急诊病例中住院需求增加。我们调查了谵妄患者的特征，这些患者被确定为CLS的一部分并接受治疗，以确定60例患者。CLS诊断谵妄占34%，谵妄患者多为55岁以上的术后患者，表现为脱水、肝肾功能障碍、呼吸功能、贫血、营养不良、IVH置管等，谵妄状态时血钠水平较谵妄前明显降低，尿量增加。谵妄患者的未确诊疾病按患病率、恶性肿瘤、恶性肿瘤、 ...更多信息 直到最近，精神抑制剂如氟哌啶醇、奥昔哌汀和硫必利在日本是用于治疗derlirum的主要药物。然而，使用精神抑制剂有时会引起过度镇静，锥体外系症状和其他不良副作用。因此，我们采用谵妄评定量表对患者进行评估，并测定血浆浓度、游离MHPG和HVA浓度，以研究米安色林（M）对谵妄的影响。结果，M的血浆浓度在治疗开始后24小时达到治疗水平。根据临床结果和血浆M浓度的测量，由于M起效快且副作用少，因此可认为其在治疗谵妄方面有效。M治疗谵妄的疗效与氟哌啶醇相似，但安全性更高。尽管给药后观察到谵妄状态改善和血浆游离MHPG浓度降低。在谵妄状态下较高的血浆游离MHPG浓度表明存在一种预备状态，其中去甲肾上腺素代谢参与了与谵妄相关的异常行为的出现。这些数据表明，游离MHPG浓度可能被用作谵妄的预测因子。少

The most frequent diagnosis of patients referred to the consultation liaison service (CLS) of Kurume University Hospital was delirium. The reason for this increase include in the number of delirious patients may have been due to the increased number of elderly patients who was hospitalized and increased need for hospitalization in emegency cases. We investigated the characteristics of patients with delirium who were identified and treated as part of the CLS to determine 60 patients. Delirium was diagosed in 34% in the CLS.Most patients with delirium were over 55 years of age and were postoperative patients ; findings inbcluded dehydration, disturbances of liver and renal, respiratory function, anemia, nutritional imbalnces, and setting of tube for IVH.The serum level of Na was significantly dectreased and urinary volume was increased during the delirious state compared with pre-delirious state. Undelying diseases of patients with delirium included in order of prevalence, malignancy, ce … More rebrovascular disease, digestive disorders, and other disorders.Until recently, neuroleptics such as haloperidol, oxypertine and tiapride were the principal drugs used in the treatment of derlirum in Japan. However, the use of neuroleptics sometimes caused oversedation, extrapyramidal symptoms, and other adverse side-effects. Therefore, we studied the effects of mianserin, (M) on delirium by assessing patients with Delirium Rating Scale as well as measurement of plasma concentration, free-MHPG and HVA concentraions. As a result, the plasma concentration of M reached a therapeutic level with 24 hr of the initiation of treatment. Based on the clinical results and on measurements of the plasma M concentrations, M can be considered effective in the treatment of delirium due to its rapid onset and few side-effects. M may offer an efficacy similar to that of haloperidol in the tretment of delirium while being safer. Although improvement in the delirious state and a decrease in the plasma free-MHPG concentration were observed after drug administration. The higher plasma free-MHPG concentration in the delirious state suggests the existence of a preparatory state whreby norepinephrine metabolism in involved in the appearance of abnormal behaviors associated with delirium. These data suggest that free-MHPG concentrations could potentially be used as a predictor of delirium. Less