[罂粟摘要]肝移植术后谵妄的危险因素:系统综述和荟萃分析

肝移植术后谵妄的危险因素:系统综述和荟萃分析

贵州医科大学  麻醉与心脏电生理课题

翻译:  李奕     编辑:  严旭   审校: 曹莹

简介：本研究的目的是总结肝移植术（LT）术后谵妄（POD）的发生率和危险因素，以及肝移植术后谵妄与预后的关系。

证据获取：在Pubmed、EMBASE和Cochrane数据库中进行文献检索，以确定报告肝移植后POD的研究。使用纽卡斯尔-渥太华量表对研究质量进行评级。使用随机效应模型提取和合并效应估计值。个体风险因素的混合平均差异和优势比使用逆方差法和Mantel-Haenszel法计算，视情况而定。

证据综合：纳入8篇文章，共1434例患者。总体而言，肝移植后POD的综合估计发生率为30% (95%可信区间:20-39%)。在汇总分析中确定了14个具有统计学意义的危险因素:酒精过量、术前肾脏替代治疗(RRT)、术前住院时间(LOS)、抑郁、肝性脑病、肝功能衰竭的酒精病因、Child-Turcotte-Pugh评分、APACHE II评分、MELD评分、术前INR、术前胆红素、术中使用芬太尼、术中输注红细胞、术后氨。与无POD的患者相比，有POD的患者机械通气、术后RRT、LOS和死亡率显著增加。

结论：肝移植后的POD是一种常见的多因素病因。肝移植后POD与一些临床结果有显著相关性。围手术期的有效干预有望降低肝移植术后发生POD的风险。

原始文献来源  ：

Jian Zhou , Xiaolin Xu , Yongxin Liang, et al. Risk factors of postoperative delirium after liver transplantation: a systematic review and meta-analysis.[J].Minerva Anestesiol. 2021 Jun;87(6):684-694.

英文原文：

Risk factors of postoperative delirium after liver transplantation: a systematic review and meta-analysis

Abstract

Introduction: The aim of this study was to summarize the incidence and risk factors of postoperative delirium (POD) after liver transplantation (LT) and associations of POD after LT with outcomes.

Evidence acquisition: A literature search of Pubmed, EMBASE, and the Cochrane Databases was performed to identify studies reporting POD after LT. The Newcastle-Ottawa Scale was used to rate study quality. Effect estimates were extracted and combined using random-effect model. Pooled mean differences and odds ratios for individual risk factors were calculated using inverse-variance method and Mantel-Haenszel method, as appropriate.

Evidence synthesis: Eight articles with 1434 patients were included in the meta-analysis. Overall, the pooled estimated incidence rates of POD after LT were 30% (95% confidence interval: 20-39%). Fourteen statistically significant risk factors were identified in the pooled analysis: alcohol excess, preoperative renal replacement therapy (RRT), preoperative hospital length of stay (LOS), depression, hepatic encephalopathy, alcohol etiology of liver failure, Child-Turcotte-Pugh Score, APACHE II Score, MELD Score, preoperative INR, preoperative bilirubin, intraoperative use of fentanyl, intraoperative RBC transfusion, postoperative ammonia. Patients with POD had a significantly increased mechanical ventilation, postoperative RRT, LOS and mortality rate compared with those without POD.

Conclusions: POD after LT was common and multifactorial in etiology. There are significant associations of POD after LT with some clinical outcomes. Effective interventions during perioperative period may be promising to reduce the risk of POD after LT.

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