肝移植术后脑桥中央髓鞘溶解症四例诊治  

Diagnosis and treatment of central pontine myelinolysis after liver transplantation

作　　者：惠博[1] 刘军[1] 许世峰[1] 杨凤辉[1] 周旭[1] 公伟[1] 于光圣[1] 徐延田[1] 卢俊[1] 

机构地区：[1]山东大学山东省立医院器官移植中心,济南250021

出　　处：《中华普通外科杂志》2008年第2期85-87,共3页Chinese Journal of General Surgery

基　　金：山东省优秀中青年科学家科研奖励基金资助项目（2005BS03006）

摘　　要：目的探讨肝移植术后并发脑桥中央髓鞘溶解症（central pontine myelinolysis）的原因及诊治体会。方法回顾性分析4例肝移植术后并发CPM患者的临床资料和诊治经过。结果4例患者中有两例存在手术前后24h内血钠明显升高史，另2例术后血钠无明显升高。分别于术后9、7、5、10d发病，分别以头痛、面瘫、失语、双侧瞳孔不等大为首发症状。均经头颅磁共振（MRI）确诊为CPM，予对症支持、激素、血浆置换等治疗后1例痊愈，1例死亡，另2例遗留面瘫、肌力减弱、构音障碍等后遗症。结论肝移植是CPM的高危因素，围手术期多种病理生理因素促使其发生发展，应以预防为主。其临床表现多样。提高临床警惕和反复的MRI检查是CPM早期诊断的关键。Objective To discuss the diagnosis and treatment of central pontine myelinolysis （CPM） after liver transplantation. Methods The clinical data and diagnosis and treatment of four cases of CPM after liver transplantation in our hospital were analyzed retrospectively. Results Two patients had a history of rapid correction of hyponatremia 24 h perioperatively. Symptoms started on 9th,7th,5th and 10th day after transplantation respectively, with first symptoms include headache, facial palsy, aphasia and anisocoria. Diagnosis was established by magnetic resonance image （MRI） in all four cases. Through aggressive symptomatic management and support, corticoid and plasmapheresis, one was healed, one died, and the other two suffered from sequela of facial palsy, myodynamia attenuate, dysarthria. Conclusion Liver transplantation is a high risk factor of CPM. There are many pathophysiologic factors that facilitates CPM. Prevention is crucial. The clinical manifestations are diversity. Early diagnosis of CPM depends on clinical vigilance and MRI.

关 键 词：肝移植 脑桥中央髓鞘溶解症 并发症 症状 诊断 治疗 病例 

分 类 号：R686[医药卫生—骨科学]