非酒精性肝硬化患者接受活體肝臟移植術後於加護病房發生瞻妄之危險因子

Factors Associated with Delirium in Intensive Care Units of Non-alcoholic Cirrhotic Patients Who Received Living Donor Liver Transplantation

瞻妄是導致活體肝臟移植病患加護病房停留時間及住院天數增加的主因之一。本研究目的在探討活體肝臟移植術後瞻妄之危險因子。一個單一醫學中心、回溯性研究。收集2010-2012 年非酒精性肝硬化之活體肝臟移植病患共54 人，以CAM-ICU 評估量表診斷瞻妄。術前因子包括：肝癌、MELD score、肝性腦病變；術後因子包括：手術時間、失血量、APACHE Ⅱ score、氣管內管放置天數、感染率；血液學檢驗因子包括：FK506 level、TBIL。資料分析以Wilcoxon-Mann-Whitney 檢定及卡方檢定比較二組患者之差異，並使用多變項分析瞻妄的重要影響因子。結果31.5%（17/54）活體肝臟移植病患有瞻妄症狀，瞻妄平均於術後第8.4±7.1 天發生，症狀維持6.0±3.0 天。瞻妄組與無瞻妄組加護病房停留時間為21.5±19.4和10.2±5.7 天、住院天數為51.4±37.3 和31.4±21.3 天（p<0.05）。研究結果顯示APARCH Ⅱ score（OR:1.25；95%CI：1.09, 1.43）為瞻妄的重要危險因子。結論為要降低瞻妄發生率的方法為針對活體肝臟移植患者提供高品質的重症照顧，避免患者術後24 小時內APACHE Ⅱ score 攀高。本研究針對活體肝臟移植術後瞻妄之危險因子進行分析，結果可提供器官移植重症單位之照顧參考。

Delirium occurs in most living donor liver transplant (LDLT) patients and is independently associated with longer ICU and hospital days. This study examined the predisposing factors of delirium for patients with nonalcoholic cirrhosis after living donor liver transplantation in intensive care units. In this retrospective study, 54 nonalcoholic liver cirrhosis LDLT patients at a medical center from January 2010 to December 2012 were investigated. Preoperative factors included HCC, MELD score and hepatic encephalopathy and postoperative factors included operative time, blood loss, APACHE Ⅱ score, duration of endotracheal intubation and infection were recorded. ICU and hospital days were used as outcome variables to evaluate the impact of delirium. ICU nursing staff assessed delirium and level of consciousness at least twice a day by using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Multiple regression analysis was used to examine the relationship between delirium and clinical parameters of patients. Our result showed that 31.5% (17/54) LDLT of patients experienced at least one episode of delirium. Delirium occurred at an average of 8.4±7.1 day and lasted for 6.0±3.0 days. APACHE Ⅱ score(OR=1.25, 95%CI=1.09, 1.43) was the most important risk factor of delirium (p<0.05). Besides, delirium group's ICU stays (21.5±19.4 days) and hospital days of 51.4±37.3 days which were significantly higher than those of no delirium group. APACHE Ⅱ score within 24 hours after LDLT was the pivotal factor of delirium. High-quality critical care and stabilized vital signs can reduce the incidence of delirium. These results can provide organ transplantation centers a guide to plan clinical care for nonalcoholic liver cirrhosis LDLT patients.