肝移植受者术后谵妄发病危险因素分析

Risk Factors and Prognosis of Delirium After Liver Transplantation

目的分析肝移植受者术后谵妄的发病率、发病时机及危险因素。方法收集2019年1月–2021年12月在中南大学湘雅三医院行肝移植的211例受者的临床资料,调查术后谵妄发病率及发病时间,采用单因素和多因素logistic回归分析谵妄发病的危险因素,并分析谵妄对受者临床结局的影响。结果肝移植受者术后谵妄的发病率为20.4%(43/211),发病距离肝移植手术的中位时间为19 h。单因素分析显示术前终末期肝病模型(model for end-stage liver disease,MELD)评分≥22、术前住院天数≥7 d、肝癌、术前肝性脑病、术前两个月内感染、术前淋巴细胞值<0.5×109 L-1、术中大量红细胞输注及使用碳青霉烯类抗生素≥3 d与肝移植受者术后谵妄发生相关。多因素logistic回归分析显示术前两个月内感染〔比值比(odds ratio,OR)=2.597,95%置信区间(confidence interval,CI):1.135~5.944,P=0.024〕,术前MELD评分≥22(OR=2.967,95%CI:1.104~7.975,P=0.031)及术前肝性脑病(OR=4.700,95%CI:2.083~10.602,P<0.001)是肝移植受者术后谵妄发生的独立危险因素,而使用碳青霉烯类抗生素≥3 d(OR=0.192,95%CI:0.083~0.441,P<0.001)是保护肝移植受者术后免于发生谵妄的因素。对临床结局而言,发生谵妄者相较未发生谵妄者术后ICU住院时间延长(P=0.025)。结论肝移植术后谵妄发病率高,发病时间早。发病危险因素包括术前感染、高MELD评分及肝性脑病,而使用碳青霉烯类抗生素能预防谵妄发生。

Objective To analyze the incidence,the onset time,and the risk factors of delirium after liver transplantation(LT).Methods The clinical data of 211 patients who underwent LT at Third Xiangya Hospital,Central South University between January 2019 and December 2021 were collected to investigate the incidence and the onset time of postoperative delirium.Univariate analysis and multivariate logistic regression analysis were conducted to analyze the risk factors of delirium and to analyze the effect of delirium on clinical outcomes.Results The incidence of delirium was 20.4%(43/211)and the median interval between LT and the onset of delirium was 19 hours.Univariate analysis showed that the preoperative Model for End-Stage Liver Disease(MELD)score≥22,preoperative length-of-stay≥7,liver cancer,preoperative hepatic encephalopathy,infections within 2 months before LT,preoperative lymphocyte value<0.5×109 L-1,massive amount of intraoperative red blood cell infusion,and carbapenem antibiotics use for 3 days or longer were associated with postoperative delirium.Multivariate logistic regression analysis showed that preoperative infections within 2 months before LT(odds ratio[OR]=2.597,95%confidence interval[CI]:1.135-5.944,P=0.024),preoperative MELD score≥22(OR=2.967,95%CI:1.104-7.975,P=0.031),and preoperative hepatic encephalopathy(OR=4.700,95%CI:2.043-10.602,P<0.001)were independent risk factors for delirium after LT,while carbapenems antibiotics use for 3 days or longer(OR=0.192,95%CI:0.083-0.441,P<0.001)was a protective factor for postoperative delirium among LT recipients.Regarding clinical outcomes,patients with delirium had longer postoperative ICU lengthof-stays than those without delirium did(P=0.025).Conclusion There is a high incidence of postoperative delirium among patients who undergo LT and the onset time of delirium after LT is early.Risk factors include preoperative infections,high MELD score,and hepatic encephalopathy.On the other hand,the use of carbapenems can help prevent delirium.