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肝移植术后谵妄的危险因素分析及预测指标评估

陈俊国 王昊 颉斌 贺志军 李亭

陈俊国, 王昊, 颉斌, 等. 肝移植术后谵妄的危险因素分析及预测指标评估[J]. 器官移植, 2020, 11(4): 477-481. doi: 10.3969/j.issn.1674-7445.2020.04.009
引用本文: 陈俊国, 王昊, 颉斌, 等. 肝移植术后谵妄的危险因素分析及预测指标评估[J]. 器官移植, 2020, 11(4): 477-481. doi: 10.3969/j.issn.1674-7445.2020.04.009
Chen Junguo, Wang Hao, Xie Bin, et al. Risk factor analysis and predictors assessment for postoperative delirium in liver transplantation[J]. ORGAN TRANSPLANTATION, 2020, 11(4): 477-481. doi: 10.3969/j.issn.1674-7445.2020.04.009
Citation: Chen Junguo, Wang Hao, Xie Bin, et al. Risk factor analysis and predictors assessment for postoperative delirium in liver transplantation[J]. ORGAN TRANSPLANTATION, 2020, 11(4): 477-481. doi: 10.3969/j.issn.1674-7445.2020.04.009

肝移植术后谵妄的危险因素分析及预测指标评估

doi: 10.3969/j.issn.1674-7445.2020.04.009
基金项目: 

湖南省自然科学基金 2016JJ3165

详细信息
    作者简介:

    陈俊国,男,1994年生,硕士研究生,研究方向为器官移植和普通外科,Email:chenjunguo5611@csu.edu.cn

    通讯作者:

    李亭,男,1983年生,博士,副主任医师,研究方向为肝脏移植、器官获取与保存,Email:liting001@csu.edu.cn

  • 中图分类号: R617, R749.2

Risk factor analysis and predictors assessment for postoperative delirium in liver transplantation

More Information
  • 摘要:   目的  分析肝移植术后谵妄(POD)的相关危险因素和预测指标。  方法  回顾性分析232例肝移植受者的临床资料。根据有否POD将受者分为POD组(60例)和非POD组(172例)。比较两组肝移植受者的术中及术后情况,对肝移植受者POD发生的危险因素进行多因素分析,评估危险因素对肝移植受者发生POD的预测价值。  结果  肝移植受者POD发生率为25.9%。POD组手术时间、无肝期长于非POD组,术中红细胞输注量、冷沉淀输注量、乳酸水平均明显高于非POD组(均为P < 0.05);POD组术后丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、凝血酶原时间国际标准化比值(PT-INR)、血浆纤维蛋白原均明显高于非POD组(均为P < 0.05)。术前肝性脑病、血氨升高、终末期肝病模型(MELD)评分高,术后AST升高,术中无肝期长是肝移植受者发生POD的独立危险因素(均为P < 0.05)。术前血氨升高和MELD评分高对肝移植受者发生POD具有良好的预测价值,最佳截取值分别为42.6 μmol/L和18分,灵敏度分别为0.650和0.767,特异度分别为0.826和0.727。  结论  肝移植受者POD发生率较高,其中术前肝性脑病、血氨升高、MELD评分高,术后AST升高,术中无肝期长为肝移植POD发生的独立危险因素。术前血氨升高、MELD评分高是预测受者发生POD的预测指标。

     

  • 图  1  术前血氨升高和MELD评分高对肝移植受者POD发生率的预测价值

    注:A图为术前血氨的ROC曲线;B图为MELD评分的ROC曲线。

    Figure  1.  The predictive value of preoperative elevated blood ammonia and high MELD scoreon the incidence of POD among liver transplant recipients

    表  1  肝移植受者POD发生率的危险因素分析

    Table  1.   Analysis of risk factors of POD incidence in liver transplant recipients

    变量 多因素分析
    OR 95%CI P
    术前肝性脑病 2.458 1.071~5.645 0.034
    术前血氨(≥42.6μmol/L) 3.514 1.527~8.088 0.003
    术前MELD评分(≥18分) 5.321 2.227~12.433 < 0.001
    术后AST升高 1.376 1.109~1.707 0.004
    术中无肝期长 1.046 1.022~1.070 < 0.001
    注:①OR为比值比。
    CI为可信区间。
    下载: 导出CSV
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出版历程
  • 收稿日期:  2020-04-11
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2020-07-15

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