肝癌患者經肝葉切除術後譫妄之危險因素

Risk Factors for Postoperative Delirium Following Hepatectomy in Patients with Hepatocellular Carcinoma

林麗絲(Li-Zzu Lin) ； 謝佳恩(Chia-En Hsieh) ； 林惠娟(Hui-Chuan Lin) ； 王思涵(Su-Han Wang) ； 林國華(Kuo-Hua Lin) ； 林佳正(Chia-Cheng Lin) ； 陳堯俐(Yao-Li Chen)

《台灣醫學》 18卷4期 (2014/07) Pp. 390-396

https://doi.org/10.6320/FJM.2014.18(4).02

摘要

本研究探討肝癌行肝葉切除術後發生譫妄之危險因子。採回溯性設計於2009年1月至2013年7月共371例。譫妄診斷以混亂評估量表評估，收集危險因素包括：年齡、病史、身體質量指數、肝臟的評分系統、術前及術後之血液及生化學檢驗值、術中失血量、肝葉切除手術、術後併發症，及環境因素。以獨立t與卡方檢定，及邏輯式迴歸分析譫妄的危險因子。研究結果發現，術後譫妄發生率為7.8%。多變量分析顯示年紀越大（OR=1.130; p＜.001）與術後血紅素較低（OR=0.764; p=.023）的病患，術後發生譫妄較高。所以本研究建議在術後應維持穩定血紅素大於11g/dL，以降低患者術後譫妄的發生。

關鍵字

肝細胞癌 ； 肝葉切除術 ； 瞻妄 ； 危險因素

並列摘要

Postoperative delirium often occurred in patients after major surgery and results in longer hospital stay and higher complication rate. However, the incidence and risk factors of postoperative delirium following hepatectomy in patients with hepatocellular carcinoma (HCC) are not well documented. The aim of this study was to evaluate the prevalence and risk factors for postoperative delirium following hepatectomy in patients with HCC. Between January 2009 and July 2013, 371 patients who underwent surgical hepatectomy at Changhua Christian Hospital were enrolled in the present study. Delirium was diagnosed by using Confusion Assessment Method (CAM) scale. Univariate and multivariate stepwise logistic regression analysis were performed to explore the significant risk factors for postoperative delirium. Postoperative delirium developed in 29 (7.8 %) of 371 patients. Univariate analysis revealed that age, body mass index (BMI), lung disease, hypnotics, model for end-stage liver disease (MELD sore), pre-operation albumin, blood loss, post-operation albumin, post-operation hemoglobin, overall complication, and infection complication were significantly related to the development of post-operation delirium. By multivariate analysis, age and postoperative hemoglobin levels were independent risk factors for postoperative delirium. This study revealed that advanced age and low postoperative hemoglobin levels were potential risk factors which contribute to postoperative delirium in patients with HCC.

並列關鍵字

hepatocellular carcinoma ； hepatectomy ； delirium ； risk factors

參考文獻

15. 劉建良、陳亮恭：老年譫妄症。台灣老誌 2011;6:1-14.[Liu CL, Chen LK: Delirium in older persons. Taiwan Geriatr Gerontol 2011;6:1-14]

16. 顏兆熊：老人之譫妄。當代醫學 2009;32:921-31.[Xiong YZ: Delirium in elderly. Medicine Today 2009;32:925-31.]

14. 李新南、潘志泉：譫妄及其治療。台灣醫學 2003;7:611-7[Lee HN, Pan CC: Delirium and its therapy. Formosan J Med 2003;7:611-7]

1. Adamis D, Treloar A, Martin FC, et al: A brief review of the history of delirium as a mental disorder. Hist Psychiatry 2007;18:459-69.

2. Marcantonio ER, Kiely DK, Simon SE, et al: Outcomes of older people admitted to postacute facilities with delirium. J Am Geriatr Soc 2005;53:963-9.