原位肝移植术后弥漫性脑病的临床研究  

Diffusive encephalopathy following liver transplantation

作　　者：易述红[1] 许赤[1] 陆敏强[1] 蔡常洁[1] 杨扬[1] 李华[1] 易慧敏[1] 汪根树[1] 赵辉[1] 李敏如[1] 陈规划[1] 

机构地区：[1]中山大学附属第三医院肝脏移植中心中山大学器官移植研究所,广州510630

出　　处：《中华神经医学杂志》2006年第9期928-930,共3页Chinese Journal of Neuromedicine

基　　金：国家重点基础研究发展计划(973课题)项目基金(2003CD515507)广州市科技局计划项目基金(2005Z3-E0101)

摘　　要：目的观察肝移植术后弥漫性脑病的发生及临床表现,探讨其易发因素及防治方法。方法回顾性分析自2003年10月至2005年9月完成的467例肝移植患者的临床资料,对肝移植术后并发弥漫性脑病的病例进行统汁分析并结合文献进行讨论。结果术后共有72例患者发生弥漫性脑病,发生率为15．41%；平均发生时间在术后(8．4±4．3)d。高龄、术前高胆红素坦率血症、高渗透压、低血小板、肺部严重感染与弥漫性脑病密切相关。68例患者痊愈,3例死于感染．1例死于移植物抗宿主病。结论弥漫性脑病是肝移植术后常见并具有潜在危险性的并发症,产生的原因是多因素的,钙调神经蛋白抑制剂的神经毒性只是一个促进因素。针对病因的综合治疗和免疫抑制剂的及时调整有利于改善预后。Objective To study the clinical features, underlying mechanism and management of diffusive encephalopathy following liver transplantation. Methods The data of 467 patients undergoing liver transplantation from Oct 2003 to Sep 2005 in the third affiliated hospital, Sun Yat-sen University, were retrospectively reviewed. Results The most common neurological complication was diffusive encephalopathy, found 8.4-4.3 days right after transplantation in 72 cases （15.41%）. Ages, preoperative hyperbilirubinemia, plasma hyperosmolality, low blood platelet count, severe pulmonary infections were independent predictors for diffusive encephalopathy following liver transplantation. Following treatment, 68 patients were cured, 3 died from severe infections and 1 patients died from Graft Versus Host Disease （GVHD）. Conclusion Encephalopathy is recognized as common and potentially fetal diseases following liver transplantation. Several factors may contribute to this complication. Calcineurin inhibitors may play a role in accelerating the onset of encephalopathy. Etiotropic combined therapy and conversion of the immunosuppressive may contribute a lot to the outcome.

关 键 词：肝移植 脑病 并发症 

分 类 号：R747.9[医药卫生—神经病学与精神病学] R657.3[医药卫生—临床医学]