Ri Hyun-Su, Choi Yoon Ji, Park Ju Yeon, Jin Se Jong, Lee Yoon Sook, Son Jung-Min, Yoon Seung Zhoo, Shin Hye Won, Choi Byung Hyun, Lee Tae Beom
Department of Anaesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
Department of Anaesthesiology and Pain Medicine, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.
Transplant Proc. 2020 Jan-Feb;52(1):219-226. doi: 10.1016/j.transproceed.2019.11.012. Epub 2019 Dec 27.
The preoperative elevation of ammonia may be associated with postoperative neurologic complications. The aim of this study was to evaluate the effect of preoperative ammonia level on the incidence of delirium in patients after liver transplantation (LT).
Patients (n = 260) who received LT from January 2010 to July 2017 in a single university hospital were retrospectively reviewed. The patients' demographic data, perioperative managements, and postoperative complications were assessed. Patients were divided into the following 2 groups: those who had a preoperative elevation (Group A, n = 158) and those with a normal range (Group C, n = 102). The cut-off value for a normal serum ammonia level in our hospital was defined as 32 μg/dL.
After propensity score matching, there was no difference in the incidence of delirium between the groups (P = .784). Delirium occurred in 8 of 68 (11.76%) patients in Group A and 7 of 68 (10.29%) patients in Group C after LT. In addition, there was no difference in the incidence of delirium between the groups, even patients were categorized based on serum ammonia levels into 3 groups as follows: < 32 μg/dL (28/158 [17.72%]), 32 to 65 μg/dL (28/158 [17.72%]), and >65 μg/dL (28/158 [17.72%]) (P = .134).
The preoperative serum ammonia level was not related with the incidence of postoperative delirium. The high elevation group, especially those with greater than 65 μg/dL of preoperative ammonia, was also not related with the incidence of delirium. However, our study is limited by its retrospective design, so future prospective studies are needed.
术前血氨升高可能与术后神经系统并发症有关。本研究旨在评估术前血氨水平对肝移植（LT）患者谵妄发生率的影响。
回顾性分析2010年1月至2017年7月在某大学医院接受LT的260例患者。评估患者的人口统计学数据、围手术期管理及术后并发症。患者分为以下两组：术前血氨升高组（A组，n = 158）和血氨正常范围组（C组，n = 102）。我院正常血清氨水平的临界值定义为32μg/dL。
倾向评分匹配后，两组谵妄发生率无差异（P = 0.784）。LT术后，A组68例患者中有8例（11.76%）发生谵妄，C组68例患者中有7例（10.29%）发生谵妄。此外，即使根据血清氨水平将患者分为以下3组：<32μg/dL（28/158 [17.72%]）、32至65μg/dL（28/158 [17.72%]）和>65μg/dL（28/158 [17.72%]），两组谵妄发生率仍无差异（P = 0.134）。
术前血清氨水平与术后谵妄发生率无关。高血氨组，尤其是术前氨水平大于65μg/dL的患者，也与谵妄发生率无关。然而，本研究受其回顾性设计的限制，因此需要未来进行前瞻性研究。
