酒精性肝硬化患者行活體肝臟移植術後加護病房瞻妄之危險因子分析

瞻妄是造成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。目標：本研究目的在探討酒精性肝硬化患者行活體肝臟移植術後加護病房瞻妄之危險因子。方法：本研究為回溯性研究，收集彰化基督教醫院2010－2012年酒精性肝硬化之活體肝臟移植病患共36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：FK 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logistic regression分析瞻妄的重要影響因子。結果：58.3%（21/36）活體肝臟移植病患有瞻妄症狀，瞻妄平均於術後第5.9 ± 3.5天發生，症狀維持4.2 ± 1.8天。瞻妄組與無瞻妄組加護病房停留時間10.3 ± 4.9 VS 7.8 ± 3.1天、住院天數32.1 ± 13.9 VS 21.4 ± 4.9天（p＜0.05）。研究結果顯示MELD score（OR：1.31；95%CI：1.04，1.63）及肝性腦病變（OR：1.65；95%CI：1.49，1.83）為瞻妄的重要危險因子。結論：瞻妄的術前危險因子為MELD score及肝性腦病變，要降低瞻妄發生率較可行的方法為針對活體肝臟移植患者術前密切監測病患神經症狀程度及血中NH3值，術後須密切評估情緒變化及認知功能。出現瞻妄症狀需適時給予抗精神病藥物haloperidol使用。若是病患病情許可，應早期轉出加護病房，減少瞻妄持續時間。本研究結果可提供器官移植重症單位臨床照顧參考。

關鍵字

酒精性肝硬化；活體肝臟移植；瞻妄

並列摘要

Delirium occurs in most living donor liver transplant (LDLT) patients and is independently associated with longer ICU and hospital days.Objective: Predisposing delirium factors of alcoholic liver cirrhosis with living donor liver transplantation in intensive care units.Method: A prospective cohort investigation of 36 alcoholic liver cirrhosis LDLT patients at a medical center between January 2010 to December 2012. Preoperative factors include HCC, MELD score and hepatic encephalopathy. Postoperative factors include operative time, blood loss, APACHE Ⅱ score, endotracheal tube days and infection. 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 per day by using the Confusion Assessment Method for the Intensive Care Unit (CAMICU). Stepwise regression method was used to independent relationship between delirium and clinical parameters of patients.Result: 58.3% (21/36) LDLT patients experienced at least one episode of delirium. Delirium occurred average on the 5.9 ± 3.5 day and maintain 4.2 ± 1.8 days. MELD score (OR: 1.31; 95%CI: 1.04, 1.63) and hepatic encephalopathy (OR: 1.65; 95%CI: 1.49, 1.83) were the important risk factors of delirium (p ＜ 0.05). Besides, delirium group ICU stay 10.3 ± 4.9 days and hospital days 32.1 ± 13.9 days were significantly higher than the no delirium group.Conclusion: Preoperative we must close moniter neurological symptoms, ammonia level and postoperative we assess the changes in mood and cognitive function. These results could provide the organ transplantation center a reference to planning clinical care for non alcoholic liver cirrhosis LDLT patients.

並列關鍵字

Alcoholic liver cirrhosis ； Living donor liver transplantation ； Delirium

國際替代計量

酒精性肝硬化患者行活體肝臟移植術後加護病房瞻妄之危險因子分析

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