肝移植受者术后谵妄发生率及危险因素的Meta分析

Incidence and risk factors of postoperative delirium in liver transplantation recipients: a Meta-analysis

目的:探讨肝移植受者术后谵妄的发生率及相关危险因素,为早期识别谵妄并构建相关模型提供依据。方法:以"肝移植""移植术""肝移植手术""肝脏移植""移植肝""谵妄""谵语""危险因素""相关因素""影响因素"和"liver transplantation""liver transplant""delirium""delirious""delirium confusion""risk factors""relevant factors""root cause analysis"为中英文关键词,检索万方数据库、中国生物医学文献数据库、中国知网(CNKI)和PubMed、Embase、Web of Science、Cochrane Library、BMJ等数据库,纳入肝移植受者术后谵妄发生率或危险因素相关文献。检索时限为建库至2022年7月12日。由2位研究者独立进行文献筛选、方法学评价、资料提取,并用RevMan5.4及State 16.0软件进行数据分析。结果:本次研究共纳入19篇文献,5003例受者,术后谵妄发生率为23%(1151/5003),汇总22项危险因素。Meta分析结果显示,有统计学意义的危险因素包括术前血氨浓度>46 mmol/L(OR=3.51,95%CI:1.53~8.09,P<0.001)、终末期肝病模型(model for end-stage liver disease,MELD)评分>15分(OR=4.24,95%CI:2.51~7.16,P<0.001)、术前肝性脑病(OR=3.00,95%CI:2.09~4.31,P<0.001)、术前使用利尿剂(OR=2.36,95%CI:1.38~4.04,P<0.001)、酗酒史(OR=3.16,95%CI:1.06~9.40,P=0.040)、无肝期时间较长(OR=1.04,95%CI:1.03~1.06,P<0.001)和术后第1天天冬氨酸转氨酶浓度升高(OR=1.33,95%CI:1.15~1.53,P<0.001)。结论:术前血氨浓度>46 mmol/L、MELD评分>15分、肝性脑病、使用利尿剂、有酗酒史,术中无肝期时间较长,术后第1天天冬氨酸转氨酶升高是移植术后谵妄的危险因素,术后再插管不是术后谵妄的危险因素。

Objective To clarify the incidence and the related risk factors of postoperative delirium in liver transplantation(LT)recipients to provide rationales for early identification of delirium and constructing the related models.Methods The authors used the"肝移植""移植术""肝移植手术""肝脏移植""移植肝""谵妄""谵语""危险因素""相关因素""影响因素"and"liver transplantation""liver transplant""delirium""delirious""delirium confusion""risk factors""relevant factors""root cause analysis"as the Chinese and English keywords,searching Wanfang data,China Biomedical Literature Database,CNKI,PubMed,Embase,Web of Science,Cochrane Library,BMJ and the literature for the incidence or risk factors of postoperative delirium in LT recipients.The researchers independently performed literature screening,methodological evaluation and data extraction.And RevMan 5.4 and State16.0 software were employed for data processing.Results A total of 19 articles involving 5003 samples were retrieved and 22 risk factors identifies.Meta-analysis showed that the incidence of POD was 23%(1151/5003).The statistically significant risk factors included preoperative blood ammonia concentration>46 mmol/L(OR=3.51,95%CI:1.53-8.09,P<0.001),model for end-stage liver disease(MELD)score>15 points(OR=4.24,95%CI:2.51-7.16,P<0.001),preoperative hepatic encephalopathy(OR=3.00,95%CI:2.09-4.31,P<0.001),preoperative dosing of diuretics(OR=2.36,95%CI:1.38-4.04,P<0.001),history of alcoholism(OR=3.16,95%CI:1.06-9.40,P=0.040),longer anhepatic period(OR=1.04,95%CI:1.03-1.06,P<0.001)and elevated aspartate transaminase concentration at Day 1 post-operation(OR=1.33,95%CI:1.15-1.53,P<0.001).Conclusions Preoperative blood ammonia concentration>46 mmol/L,MELD score>15,hepatic encephalopathy,dosing of diuretic,a history of alcoholism,longer anhepatic period and elevated aspartate transaminase at Day 1 post-operation are risk factors for postoperative delirium after LT.Postoperative reintubation is not a risk factor for postoperative delirium.