围手术期可逆性后部脑病综合征:1例病例报道及文献回顾  

Perioperative posterior reversible encephalopathy syndrome:a case report and literature review

作　　者：邹宇[1] 彭倩宜[2] 肖娟 Zou Yu;Peng Qianyi;Xiao Juan(Department of Anesthesiology,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Critical CareMedicine,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Anesthesiology,Suining County People's Hospital,Suining 422600,China)

机构地区：[1]中南大学湘雅医院麻醉科,长沙410008 [2]中南大学湘雅医院重症医学科,长沙410008 [3]绥宁县人民医院麻醉科,绥宁422600

出　　处：《国际麻醉学与复苏杂志》2023年第4期399-404,共6页International Journal of Anesthesiology and Resuscitation

基　　金：湖南省自然科学基金(2020JJ5959)。

摘　　要：可逆性后部脑病综合征(posterior reversible encephalopathy syndrome,PRES)是一种临床上罕见的放射学综合征,其特征是头痛、癫痫发作、意识障碍和视觉变化。大量输血、应用免疫抑制药物、低颅内压、围手术期高血压和神经外科术后的患者需警惕PRES的发生。此例PRES患者存在严重贫血,既往无高血压病史,术后出现癫痫发作和意识丧失,磁共振检查证实为PRES。通过文献检索,回顾分析了29例围手术期PRES患者,其中14例患者为女性,23例(79.3%)发生了术中或术后高血压,术后神经症状的平均发病时间为5.4 d。有效的围手术期血压管理、避免大量输血和早期诊断治疗有助于避免疾病发生、发展,促进患者早期康复,降低病死率和后遗症发生率。Posterior reversible encephalopathy syndrome(PRES)is a rare clinical⁃neuroradiological syndrome characterized by headache,seizures,disturbance of consciousness,and visual changes.Patients with risk factors,including massive blood transfusion,immunosuppressive drugs,low intracranial pressure,and perioperative hypertension,should be alert to the possibility of PRES.We presented a patient with no history of hypertension with seizures and loss of consciousness after a massive perioperative blood transfusion and two⁃stage gynecological surgeries under general anesthesia.Magnetic resonance imaging confirmed a diagnosis of posterior reversible encephalopathy syndrome.Through literature review,a total of 29 perioperative PRES cases,including the present one,have been reviewed.Among the cases,14 of 29 were female,23 patients(79.3%)developed intraoperative or postoperative hypertension,and the mean onset of neurological symptoms after the operation was 5.4 days.Effective perioperative blood pressure management,avoiding massive blood transfusion,and early diagnosis and treatment of PRES help prevent the occurrence and de⁃velopment of this disease,promoting early rehabilitation and reducing the mortality and the incidence of sequelae.

关 键 词：可逆性后部脑病综合征 围手术期 高血压 输血 

分 类 号：R614[医药卫生—麻醉学]