关于“渗透性脱髓鞘综合征”的临床进展——肝移植术后并发症机理的探讨  

On the “osmotic demyelination syndrome” Clinical Progress:liver transplantation postoperative complications

作　　者：张海鹏[1] 曾伏虎[2] 杜长生[3] 陈宗羡[2] 翟所鑫[2] 李玉清[1] 刘庆梅[1] 朱玉忠[1] 王荣明[1] 张力[4] 

机构地区：[1]河北北方学院临床医学部第七教学医院外科,河北涿鹿075000 [2]河北北方学院临床医学部第二附属医院神经外科,河北张家口075000 [3]中国人民武警部队总医院神经外科,北京100039 [4]河北北方学院基础医学部,河北张家口075000

出　　处：《河南大学学报（医学版）》2012年第1期55-64,共10页Journal of Henan University:Medical Science

基　　金：河北北方学院校立项目(2010-1001)

摘　　要：脑桥中央髓鞘溶解症(central pontine myelinolysis,CPM)自1970年代后期被联系于低血钠的快速纠正,约10年后又拓展至"渗透性脱髓鞘综合征(osmotic demyelination syndrome,ODS)[1]",及至2008年个案文献甚至提出了"可能的周围神经ODS[2]"。但不少迹象提示,诸如后述的问题或许尚无满意答案:CPM最可能的病因是什么?文献肝移植术后或严重呕吐相关的CPM或"ODS"预后极差之原因为何,如何优化其围手术期处理、如何优化重度低钠血症的治疗原则、改善预后?"ODS"累及的主要部位为何?病理机制为何?如何在纠正血钠时避免之?等等。兹对早期的、经典的或有一定代表性的病例文献的具体资料进行重新分析及商榷;在此基础上,对上述诸问题进行初步的探索和反思。Since the late of 1970s, central pontine myelinolysis（CPM）was associated with the hypokalemic non-- periodic check, after 10 years it developed into osmotic demyelination syndrome（ODS）[1], and in 2008 some literatures iust say it is possible ODS[2] . Some indications suggest that there is no satisfactory solution to it： what is the possible the main etiological factors of central pontine myelinolysis （CPM） and of the ＂osmotic demyelination syndrome（ODS） that occurs after hepatic transplantation？ Why are the differential diagnosing the manifestation consisting of dysarthria, dysphagia and quadriplegia presented after vomiting for a number of times low？ which fractions are mainly involved by the ＂ODS＂？ , what is the pathological mechanism of the ＂ODS＂ , and how is hypokalemic prevented？ We explore and retro--consider it, based on the classical case analysis literatures.

关 键 词：脑桥中央髓鞘溶解症 渗透性脱髓鞘综合征 WERNICKE脑病 肝移植术 

分 类 号：R657.3[医药卫生—外科学]