臨床整形外科58巻5号

2023年05月発行

増大号特集 できる整形外科医になる！　臨床力UP，整形外科診療のコツとエッセンス 2章　治療

術後せん妄への処方と対処法

著者： 久保馨彦¹ 竹内啓善¹

所属機関： ¹慶應義塾大学医学部精神・神経科学教室

ページ範囲：P.626 - P.632

Point!

●せん妄は身体疾患，薬剤の使用(離脱含む)などによる急性の脳機能不全症候群であり，入院期間の延長，死亡率増加，認知症のリスク増加などにもつながる．

●術前から術後までの連続的な介入がせん妄の治療の基本であり，術前にはせん妄のリスク因子の評価・軽減を図り，術後には合併症の治療や疼痛管理など介入を行う．せん妄に対する薬物療法のみでは不十分である．

●せん妄発症のリスクがある患者には，メラトニン受容体アゴニストなどの予防薬の投与を検討する．

●せん妄発症後の薬物療法では，オレキシン受容体拮抗薬，トラゾドンとミアンセリンといった鎮静系の抗うつ薬，抗精神病薬などが選択肢になりうる．高齢者への抗精神病薬の使用は死亡リスクの増加につながる報告もあり，慎重な投与が必要である．また，せん妄に対して使用した向精神薬がせん妄改善後も漫然と投与されないように注意する．

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