Yoon Jin Sun, Kim Young Ri, Choi Ji Won, Ko Justin Sangwook, Gwak Mi Sook, Kim Gaab Soo
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2009 Nov;57(5):584-589. doi: 10.4097/kjae.2009.57.5.584.
Postoperative delirium (POD) after liver transplantation is a serious complication. This study investigated the incidence and the risk factors of POD in liver transplantation recipients.
Three hundred and sixty eight adult recipients who had undergone liver transplantation were included. We reviewed medical records and the POD was determined by either psychiatric consultation or established diagnostic criteria. Recipients were divided into two groups according to the occurrence of POD: POD group (n = 150) and non-POD group (n = 218), and risk factors were assessed.
One hundred fifty (40.8%) of the 368 recipients developed POD after liver transplantation. History of alcohol consumption and alcoholic liver disease, history of hepatic encephalopathy, preoperative mental status changes, ventilator care, dialysis, hypotension, and ICU care were significantly higher in the POD group. In the preoperative laboratory test, sodium was lower while bilirubin, PT (INR) and MELD score were higher in the POD group. Postoperative variables including dialysis, ventilator care duration, ICU stay, hospital stay, glucose and ammonia were significantly higher in the POD group. Three variables were identified as independent predictors of POD in a multiple regression analysis: history of alcohol consumption (odds ratio, 2.04; 95% confidence interval [CI], 1.12-3.72; P = 0.02), history of hepatic encephalopathy (odds ratio, 2.54; 95% CI, 1.46-4.41, P<0.01), and MELD score (odds ratio, 1.03; 95% CI, 1.00-1.06; P = 0.02).
The development of POD and related morbidity and mortality would be reduced if we identified the recipients with risk factors preoperatively and applied early intervention.
肝移植术后谵妄（POD）是一种严重的并发症。本研究调查了肝移植受者中POD的发生率及危险因素。
纳入368例接受肝移植的成年受者。我们查阅了病历，POD通过精神科会诊或既定的诊断标准来确定。根据POD的发生情况将受者分为两组：POD组（n = 150）和非POD组（n = 218），并评估危险因素。
368例受者中有150例（40.8%）在肝移植后发生POD。POD组的饮酒史和酒精性肝病病史、肝性脑病病史、术前精神状态改变、呼吸机护理、透析、低血压及重症监护病房（ICU）护理情况显著更多。在术前实验室检查中，POD组的钠水平较低，而胆红素、凝血酶原时间（国际标准化比值）和终末期肝病模型（MELD）评分较高。POD组的术后变量包括透析、呼吸机护理持续时间、ICU住院时间、住院时间、血糖和氨水平显著更高。在多元回归分析中，三个变量被确定为POD的独立预测因素：饮酒史（比值比，2.04；95%置信区间[CI]，1.12 - 3.72；P = 0.02）、肝性脑病病史（比值比，2.54；95%CI，1.46 - 4.41，P<0.01）和MELD评分（比值比，1.03；95%CI，1.00 - 1.06；P = 0.02）。
如果我们术前识别出有危险因素的受者并进行早期干预，POD的发生及相关发病率和死亡率将会降低。
