- 期刊
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
摘要
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.
並列摘要
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.
延伸閱讀
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