肝移植术后并发桥脑中央髓鞘溶解症三例  

Central pontine myelinolysis following liver transplantation： clinical report of 3 cases

作　　者：张中伟[1] 王文涛[2] 杨加印[2] 严律南[2] 康焰[1] 李波[2] 曾勇[2] 文天夫[2] 罗传兴[1] 

机构地区：[1]四川大学华西医院重症医疗科,成都610041 [2]四川大学华西医院肝移植中心,成都610041

出　　处：《中华器官移植杂志》2008年第9期549-551,共3页Chinese Journal of Organ Transplantation

摘　　要：目的总结肝移植术后并发桥脑中央髓鞘溶解症（CPM）的诊治体会。方法3例肝移植受者术后并发CPM，术前血清Na^＋明显偏低．分别为124mmol／L、119mmol／L和119mmol／L，术后出现自主言语较少、自主动作变缓慢、吐词不清、昏迷等症状，经头颅磁共振（MRI）检查，例1主要表现为闭锁综合征，例2、3主要表现为昏迷。例1采取静脉给予大剂量丙种球蛋白治疗，例2采取高压氧治疗．例3未能进行针对性治疔。结果3例患者术后均出现血钠快速升高，幅度达22～34mmol/L。例1术后随访3个月。基本恢复正常，但行动反应仍迟缓．肝功能正常。例2术后随访6个月．患者仍旱昏迷状态，肝功能良好。例3术后意识障碍逐渐加重。后死于肺部感染。结论CPM是肝移植术后的严重并发症，尚无有效的治疗方法，患者的预后差。Objective To summarize the clinical experience of central pontine myelin-olysis after liver transplantation. Methods The clinical data of 3 patients diagnosed as having central pontine myelinolysis following liver transplantation were reviewed. Three patients had obviously preoperative hyponatremia, and the levels of serum sodium were separately 124. 119 and 119 mmol/L. The first patient with lock in syndrome received large dosage of immunoglobulin; The second and the third patients had coma, and the third patients received hyperbaric oxygen treatment. Results The levels of serum sodium in 3 patients were risen sharply. The first patient had been recovery nearly after 3 months, the second patient had been no return in 6 months, and the third patient was died from pulmonary infection. Conclusion Central pontine myelinolysis threatened the patients＇ life following liver transplantation seriously.

关 键 词：肝移植 髓鞘溶解 中心性桥脑 

分 类 号：R657.3[医药卫生—外科学]