痴呆症にみられたせん妄について―痴呆病棟入院患者における実態

An Analysis of Delirium in Demented Inpatients

抄録

　せん妄は，痴呆症に合併しやすく，その介護や看護において最も問題になる症状である。我々は，自宅または介護施設から精神科病院痴呆病棟に入院した男性227名，女性207名の計434名の患者について，入院時にせん妄を伴った群と伴わなかった群に区分し，患者側の要件や介護者の状況などについて比較検討した。

　せん妄群には男性が有意に多く，入院時年齢の平均値が有意に高かった。身体合併症の併発率はせん妄群で有意に高率で，内訳としては高血圧と心疾患の合併率が有意に高かった。診断については，せん妄群の入院患者には血管性痴呆やレビー小体型痴呆が有意に多かったが，逆にアルツハイマー型痴呆や前頭側頭型痴呆は有意に少なかった。介護者について，せん妄群では妻のみが介護している状況が有意に高率だった。入院時にみられた精神症状や行動異常については，せん妄群では，睡眠障害，暴力・興奮，幻覚・妄想，自傷行為・希死念慮といった項目が有意に高率であった。以上は痴呆症におけるせん妄合併の危険要因と考えられた。

Summary

　Delirium is a troublesome matter especially in care-giving and nursing care. We have investigated some factors concerning delirium in demented inpatients on their admission to Yokohama Maioka hospital. 434 patients (male；227, female；207) were divided into two groups with or without delirium for statistical analysis.

　In the group with delirium, male patients were significantly greater in number than those in the group without delirium. The age at admission was also significantly older. The former group had significantly more complications of hypertension and/or heart diseases. In addition, the significant majority of delirium patients was diagnosed as having vascular dementia or dementia with Lewy bodies. Sleep disturbance, violence agitation, delusion, hallucination and suicidal tendencies were also detected with significantly greater frequency. In the majority of male patients with delirium, their wives were the sole care-givers. These conditions in demented patients are considered as risk factors related to delirium.