肝脏手术患者术后谵妄影响因素的系统评价

A systematic review of influencing factors of postoperative delirium in patients with liver surgery

目的:系统评价肝脏手术患者术后谵妄的危险因素,以期为临床早期预防肝脏手术患者术后谵妄提供参考依据。方法:计算机检索PubMed、Web of Science、Cochrane Library、Embase、中国知网、万方数据库、维普网、中国生物医学文献数据库,检索时间为建库至2021年7月31日。由2名研究者进行文献筛选、质量评价、数据提取。采用RevMan 5.4软件进行数据分析。结果:最终纳入15篇文献。Meta分析结果显示,高龄( OR=1.13,95% CI:1.06~1.22, Z=3.49, P=0.000 5)、脑血管病史( OR=3.27,95% CI:1.89~5.66, Z=4.24, P<0.000 1)、肝性脑病史( OR=2.49,95% CI:1.70~3.65, Z=4.68, P<0.000 01)、精神疾病史( OR=2.82,95% CI:1.52~5.22, Z=3.30, P=0.001)、镇静催眠药使用史( OR=4.12,95% CI:1.99~8.52, Z=3.82, P=0.000 1)、饮酒史( OR=1.96,95% CI:1.18~3.26, Z=2.61, P=0.009)、术后感染( OR=5.76,95% CI:4.24~7.84, Z=11.18, P<0.000 01)是肝脏手术患者术后谵妄的独立危险因素;术前白蛋白水平升高( OR=3.31,95% CI:0.19~0.52, Z=4.52, P<0.000 01)是肝脏手术患者术后谵妄的保护性因素。终末期肝病模型评分、术前血清总胆红素水平升高、术后血清钠水平升高、术后入住ICU以及急性生理与慢性健康评分对肝脏手术患者术后谵妄的影响差异无统计学意义( P>0.05)。 结论:高龄、脑血管病史、精神疾病史、肝性脑病史、镇静催眠药使用史、饮酒史、术后感染是肝脏手术患者术后谵妄的独立危险因素,术前白蛋白水平升高是术后谵妄的保护性因素。

Objective To systematically review the risk factors of postoperative delirium in patients with liver surgery,in order to provide reference for early clinical prevention of postoperative delirium in patients with liver surgery.Methods PubMed,Web of Science,Cochrane Library,Embase,China National Knowledge Infrastructure(CNKI),Wanfang Database,VIP and China Biomedical Literature Database were searched by computer from the establishment of the database to July 31,2021.Two researchers conducted literature screening,quality evaluation and data extraction.RevMan 5.4 was used for data analysis.Results Finally,15 articles were included.Meta-analysis results showed that advanced age(OR=1.13,95%CI:1.06-1.22,Z=3.49,P=0.0005),history of cerebrovascular disease(OR=3.27,95%CI:1.89-5.66,Z=4.24,P<0.0001),history of hepatic encephalopathy(OR=2.49,95%CI:1.70-3.65,Z=4.68,P<0.00001),history of mental illness(OR=2.82,95%CI:1.52-5.22,Z=3.30,P=0.001),history of sedative-hypnotic use(OR=4.12,95%CI:1.99-8.52,Z=3.82,P=0.0001),history of drinking(OR=1.96,95%CI:1.18-3.26,Z=2.61,P=0.009),postoperative infection(OR=5.76,95%CI:4.24-7.84,Z=11.18,P<0.00001)were independent risk factors for postoperative delirium in patients with liver surgery.Increased preoperative albumin level(OR=3.31,95%CI:0.19-0.52,Z=4.52,P<0.00001)was a protective factor for postoperative delirium in patients undergoing liver surgery.There were no statistically significant differences in effects of end-stage liver disease model score,preoperative serum total bilirubin level,postoperative increased serum sodium level,postoperative ICU admission,acute physiology and chronic health scores on postoperative delirium in patients with liver surgery(P>0.05).Conclusions Advanced age,history of cerebrovascular disease,history of mental illness,history of hepatic encephalopathy,history of sedative-hypnotic use,history of alcohol consumption and postoperative infection are independent risk factors for postoperative delirium in patients with liver surgery,and elevated preoperative albumin level is associated with postoperative delirium.protective factor.