摘要
目的探讨肝移植术后早期严重中枢神经系统并发症的种类、发病原因及防治措施。方法回顾性分析2001年7月至2006年7月实施的347例肝移植患者临床资料,比较分析肝移植后早期无神经系统并发症和有严重中枢神经系统并发症两组与原发疾病、血钠、血镁、血浆渗透压、凝血功能等的关系。结果347例肝脏移植患者中71例(20.46%)出现与移植相关的精神神经系统并发症,其中6例(1.73%)出现严重中枢神经系统并发症,包括脑水肿、脑出血、脑桥中央髓鞘溶解症(central pontine myelinolysis,CPM),其中5例死亡。肝硬化失代偿、脾亢的患者术后严重中枢神经系统并发症发病率高。与无神经系统并发症组比较,脑出血患者术前均有脾亢、凝血功能不良明显;CPM和脑水肿患者移植前均存在严重的顽固性、慢性低钠血症,移植术前后48h内血钠及血浆渗透压变化明显。结论肝移植受体术后严重中枢神经系统并发症的发生与原发疾病有关,并可能与术前慢性低钠血症、围手术期血钠和血浆渗透压大幅波动、凝血功能未及时纠正有关。
Objective To study the classification, possible causes, cure and prevention measures of serious central nervous system （CNS） complications occurring early following liver transplantation. Methods The clinical material records of 347 patients undergoing the orthotopic liver transplantation from July 2001 to July 2006 were analyzed retrospectively. The perioperation risk factors of CNS complications, which might be the primary liver disease, serum sodium level, magnesium level, fluctuation degree of plasma osmolality and serum sodium, function of blood clotting, etc. , were analyzed between patients with serious CNS complications and without neurological complications. Results A total of 71 （20. 46%） neurological symptoms appeared in 347 postoperative patients who included 6 cases （1. 73%） with serious CNS complications such as cerebral edema, cerebral hemorrhage and central pontine myelinolysis, and of 6 cases, 5 patients died. The morbidity of early serious complications of CNS was higher in patients with decompensate cirrhosis and/or hypersplenism. Compared with the group of no neurological complications, two patients with cerebral hemorrhage suffered from preoperative hypersplenism and worse dysfunction of blood clotting （P〈0.05）; patients with developed CPM and cerebral oedema had serious hyponatremia history before operation, and intensely fluctuated plasma osmolality showed before and after operation. Conclusion The onset of serious complications of CNS in recipients of liver transplantation may be intimately related to the primary liver disease, and be associated with chronic hyponatremia, rapid correction of serum sodium concentration, intense increase of plasma osmolality and no prompt rectification of the function of blood clotting during perioperation.
出处
《四川大学学报（医学版）》
CAS
CSCD
北大核心
2007年第3期535-538,共4页
Journal of Sichuan University(Medical Sciences)
关键词
肝移植
脑水肿
脑出血
脑桥中央髓鞘溶解症
低钠血症
Liver transplantation Cerebral oedema Cerebral hemorrhage Central pontine myelinolysis （CPM） Hyponatremia
