간이식 수술 후 발생한 술 후 섬망의 위험 인자에 대한 고찰 (Risk factors of postoperative delirium following liver transplantation)

서지정보

· 발행기관 : 대한마취통증의학회
· 수록지 정보 : Korean Journal of Anesthesiology / 57권 / 5호 / 584 ~ 589페이지
· 저자명 : 윤진선, 김영리, 최지원, 고저스틴상욱, 곽미숙, 김갑수

초록

Background: Postoperative delirium (POD) after liver transplantation is a serious complication. This study investigated the incidence and the risk factors of POD in liver transplantation recipients.
Methods: Three hundred and sixty eight adult recipients who had undergone liver transplantation were included. We reviewed medical records and the POD was determined by either psychiatric consultation or established diagnostic criteria. Recipients were divided into two groups according to the occurrence of POD: POD group (n = 150) and non-POD group (n = 218), and risk factors were assessed.
Results: One hundred fifty (40.8%) of the 368 recipients developed POD after liver transplantation. History of alcohol consumption and alcoholic liver disease, history of hepatic encephalopathy, preoperative mental status changes, ventilator care, dialysis, hypotension, and ICU care were significantly higher in the POD group. In the preoperative laboratory test, sodium was lower while bilirubin, PT (INR) and MELD score were higher in the POD group. Postoperative variables including dialysis, ventilator care duration, ICU stay, hospital stay, glucose and ammonia were significantly higher in the POD group. Three variables were identified as independent predictors of POD in a multiple regression analysis: history of alcohol consumption (odds ratio, 2.04; 95% confidence interval [CI], 1.12−3.72; P = 0.02), history of hepatic encephalopathy (odds ratio, 2.54; 95% CI, 1.46−4.41, P ＜ 0.01), and MELD score (odds ratio, 1.03; 95% CI, 1.00−1.06; P = 0.02).
Conclusions: The development of POD and related morbidity and mortality would be reduced if we identified the recipients with risk factors preoperatively and applied early intervention.

영어초록

Background: Postoperative delirium (POD) after liver transplantation is a serious complication. This study investigated the incidence and the risk factors of POD in liver transplantation recipients.
Methods: Three hundred and sixty eight adult recipients who had undergone liver transplantation were included. We reviewed medical records and the POD was determined by either psychiatric consultation or established diagnostic criteria. Recipients were divided into two groups according to the occurrence of POD: POD group (n = 150) and non-POD group (n = 218), and risk factors were assessed.
Results: One hundred fifty (40.8%) of the 368 recipients developed POD after liver transplantation. History of alcohol consumption and alcoholic liver disease, history of hepatic encephalopathy, preoperative mental status changes, ventilator care, dialysis, hypotension, and ICU care were significantly higher in the POD group. In the preoperative laboratory test, sodium was lower while bilirubin, PT (INR) and MELD score were higher in the POD group. Postoperative variables including dialysis, ventilator care duration, ICU stay, hospital stay, glucose and ammonia were significantly higher in the POD group. Three variables were identified as independent predictors of POD in a multiple regression analysis: history of alcohol consumption (odds ratio, 2.04; 95% confidence interval [CI], 1.12−3.72; P = 0.02), history of hepatic encephalopathy (odds ratio, 2.54; 95% CI, 1.46−4.41, P ＜ 0.01), and MELD score (odds ratio, 1.03; 95% CI, 1.00−1.06; P = 0.02).
Conclusions: The development of POD and related morbidity and mortality would be reduced if we identified the recipients with risk factors preoperatively and applied early intervention.

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