Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China.
Eur Rev Med Pharmacol Sci. 2021 Apr;25(8):3246-3253. doi: 10.26355/eurrev_202104_25733.
Postoperative delirium (POD) is a common complication after surgery. The incidence of POD and delirium risk factors after liver transplantation (LT) have not been systematically summarized.
Databases, such as PubMed, Cochrane Library, and EMBASE were searched up to September 15, 2019. All relevant studies that addressed the incidence and risk factors for POD after LT were included and summarized.
Twenty articles with 3417 patients with LT were included. The pooled overall incidence for POD after LT was 0.16 (95% CI 0.12-0.22). The overall incidence (0.24, 95% CI 0.15-0.35) in Asians was higher than in Caucasians (0.13, 95% CI 0.08-0.19). Encephalopathy (OR 4.16, 95% CI 2.59-6.68, p<0.01), alcoholic liver disease (OR 2.25, 95% CI1.46-3.47, p<0.01), MELD score, midazolam use, duration of ICU stay (day), and duration of hospital stay (day) were significantly associated with POD. POD was a mortality risk factor according to the pooled results of ICU mortality (OR 5.06, 95% CI 1.42-17.99), in-hospital mortality (OR 4.05, 95% CI 1.86-8.84), and one-year mortality (OR 4.21, 95% CI 1.94-9.12).
POD is common after LT and leads to a worse outcome. Several risk factors were consistently associated with POD after LT. The risk factors identified by this study may benefit the prevention and diagnosis of POD. This study is the first to summarize the occurrence of POD after LT.
术后谵妄（POD）是手术后的一种常见并发症。肝移植（LT）后 POD 的发生率和谵妄危险因素尚未得到系统总结。
检索了 PubMed、Cochrane Library 和 EMBASE 等数据库，截至 2019 年 9 月 15 日，纳入了所有涉及 LT 后 POD 发生率和危险因素的相关研究并进行了总结。
共纳入 20 篇研究，包含 3417 例 LT 患者。LT 后 POD 的总发生率为 0.16（95%CI 0.12-0.22）。亚洲人群的总体发生率（0.24，95%CI 0.15-0.35）高于白种人（0.13，95%CI 0.08-0.19）。脑病（OR 4.16，95%CI 2.59-6.68，p<0.01）、酒精性肝病（OR 2.25，95%CI 1.46-3.47，p<0.01）、MELD 评分、咪达唑仑使用、ICU 住院时间（天）和住院时间（天）与 POD 显著相关。根据 ICU 死亡率（OR 5.06，95%CI 1.42-17.99）、住院死亡率（OR 4.05，95%CI 1.86-8.84）和 1 年死亡率（OR 4.21，95%CI 1.94-9.12）的汇总结果，POD 是死亡的危险因素。
LT 后 POD 很常见，且导致预后更差。几个危险因素与 LT 后 POD 始终相关。本研究确定的危险因素可能有助于 POD 的预防和诊断。这是首次总结 LT 后 POD 的发生情况。
