儿童肝移植术后早期严重神经系统并发症15例分析  

Early severe neurological complications after pediatric liver transplantation:a report of 15 patients

作　　者：赵凯[1] 刘懿禾[1] 高伟[1] 蔡金贞[1] Zhao Kai;Liu Yihe;Gao Wei;Cai Jinzhen(Department of Transplant Surgery,Tianjin First Central Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院移植外科,300192

出　　处：《中华肝胆外科杂志》2020年第11期812-815,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金(81670600)。

摘　　要：目的:分析儿童肝移植术后早期严重神经系统并发症(ESNC)情况和相关原因。方法:回顾性分析天津市第一中心医院2018年1月至12月309例接受肝移植患儿临床资料。术后早期(肝移植术后1个月内)发生严重神经系统并发症15例(4.8%,15/309),男性7例,女性8例,年龄6~46个月。原发病胆道闭锁12例,爆发性肝功能衰竭1例,尼曼-皮克病A型1例,Alagille综合征1例。分析患儿神经系统并发症原因以及预后。结果:15例患儿肝移植术后发生ESNC平均时间为10.7(0~28)d。12例患儿发生肝移植术后脑病,其中2例合并癫痫。其中4例为严重感染引起,4例为心功能衰竭合并呼吸功能衰竭导致缺血缺氧性脑病,2例为移植肝功能衰竭所致,1例为颅内感染,1例因严重脑肿胀最终导致脑死亡。3例发生癫痫,其中2例为钙调磷酸酶抑制剂的神经毒性,1例患儿是可逆性后部白质脑病综合征。术后发生ESNC患儿死亡3例,其中1例脑死亡,1例严重心功能衰竭死亡,1例严重感染死亡。结论:儿童肝移植术后ESNC发生率为4.8%,严重影响患儿远期预后。感染、心功能不全、药物毒性等导致ESNC,治疗过程中应注意预防ESNC。Objective To study the clinical course and underlying causes of early severe neurological complication(ESNC)after pediatric liver transplantation.Methods A retrospective study was conducted on 309 pediatric liver transplantation recipients treated at Tianjin First Central Hospital from January 2018 to December 2018.ESNC occurred in 15 patients(4.8%,15/309)within 1 month after liver transplantation.There were 7 males and 8 females,aged from 6 to 46 months.Liver transplantation was carried out for biliary atresia(n=12),fulminant liver failure(n=1),Niemann-Pick disease(n=1)and Alagille syndrome(n=1).The causes of ESNC and the prognosis were analyzed.Results The onset of ESNC was 10.7(0-28)d after liver transplantation.Twelve patients developed encephalopathy with epilepsy in 2 patients.Four of these patients were caused by severe infection,4 by heart failure combined with respiratory failure which led to ischemic hypoxic encephalopathy,2 by transplant liver failure,1 by intracranial infection,and 1 by severe brain swelling which led to brain death.Epilepsy occurred in 3 patients,2 caused by neurotoxicity of calcineurin inhibitors,and 1 caused by reversible posterior leukoencephalopathy syndrome.Three children with ESNC died after operation,including 1 brain death,1 due to severe heart failure and 1 due to severe infection.Conclusions ESNC occurred in 4.8%of patients which seriously affected long-term prognosis of patients.Measures to reduce the incidence of ESNC include prevention of postoperative infection and drug toxicity,and good control of cardiac insufficiency.

关 键 词：肝移植 儿童 神经并发症 早期 

分 类 号：R726.5[医药卫生—儿科]