肝移植术后神经精神系统并发症:3例回顾性分析及文献复习

报告2001—03／2004—08在潍坊市人民医院肝胆血管外科收治的3例肝移植术后神经精神病发症患者，其中2例为谵妄样精神障碍，1例出现癫痫及肢体运动障碍，主要给与调整免疫抑制剂药物治疗、及时纠正水电解质紊乱及对症处理。观察术后患者预后情况，并对各病例诊治过程给予回顾性观察。病例1，男，54岁，乙型肝炎肝硬变并大肝癌。有高血压史15年，糖尿病史10年。2001—09—25行背驮式肝移植。术中、术后曾应用甲强龙1000mg冲击治疗。术后28d因高胆红素血症，高钾血症，肝肾功能衰竭临床死亡。病例2，男，47岁，乙型肝炎，肝硬变并巨大肝癌，慢性结石性胆囊炎。有高血压史5年，糖尿病史2年。2001—12-26行背驮式肝移植。术后44d时有明显的咳嗽、咳黄绿色痰，痰培养有曲霉菌属（50％），给与大扶康治疗效果可。至53d时，出现嗜睡、精神委靡，54d时出现神志不清，55d时出现右侧偏瘫，逐渐昏迷，经脑CT检查证实为脑内出血，最后死亡。病例3，男，59岁，乙型肝炎，肝硬化肝萎缩合并右肝小肝癌。2004—08—20日行原位改良经典式肝脏移植手术，无体外静脉转流。术后4d突发性失语、逐步出现运动功能障碍，吞咽功能障碍，烦躁等情况，并有癫痫发作，经给予苯妥英钠、水合氯醛灌肠、鲁米那钠等治疗后，局灶型癫痫发作、烦躁等症状得到有效控制，但仍有失语、左侧偏瘫。术后5个月脑出血死亡。肝移植术后神经精神病发症发生率较高。而脑出血则是严重的并发症，死亡率很高。术中减少出血，维持血流动力学和内环境的稳定，避免大量的输血及输液对于预防该严重并发症的发生有重要的积极意义。

Neuropsychiatric complications after liver transplantation: Retrospective analysis of three cases and literature review

It was reported that three cases of neuropsychiatric complications after liver transplantation were enrolled from Department of Hepatobiliary Surgery, Weifang People's Hospital from March 2001 to August 2004. Two cases of delirium kind of mental disorder, and one patient had epilepsy and limb movement disorder. All subjects were mainly given immunosuppressant drug therapy, a timely correction of fluid and electrolyte imbalance and symptomatic treatment. Postoperative prognosis of patients as well as the diagnosis and treatment of patients were retrospectively observed. Case one, male aged 54 years of hepatitis B liver cirrhosis and large, with a history of hypertension for 15 years and diabetes for 10 years. On September 25th, 2001 the patient received piggyback liver transplantation. During and after transplantation the patient received a strong impact on the treatment with the Dragon 1 000 mg. After 28 days,the patient died of hyperbilirubinemia, hyperkalemia, liver and kidney failure clinically. Case two, male aged 47 years of hepatitis B, cirrhosis and huge hepatocellular carcinoma, chronic calculous cholecystitis, with a history of hypertension for 5 years and diabetes for 2 years. On December 26th, 2001 the patient was treated with piggyback liver transplantation. At day 44 the patient had obvious cough with yellow-green phlegm, sputum culture was Aspergillus spp (50%) and diflucan for the treatment. Till day 53, drowsiness and depressed spirit appeared; at day 54, the patient was disoriented, and at day 55 hemiparesis occurred at right side, gradually coma, by brain CT scan it confirmed to be intracerebral hemorrhage, and died. Case three, male aged 59 years of hepatitis B, cirrhosis of liver atrophy with right hepatic small hepatocellular carcinoma. On August 20th, 2004 the patient was given classic modified line-situ liver transplant surgery without venovenous bypass. Four days after sudden aphasia, gradually motor dysfunction, swallowing dysfunction,restlessness and epilepsy appeared. After Phenytoin Sodium, chloral hydrate enema and luminal sodium treatment, focal epilepsy and irritable symptoms were effectively controlled, but aphasia and left hemiparesis still occurred. After five months, the patient died of cerebral hemorrhage. Incidence rate of neuropsychiatric complications are high after liver transplantation. Besides, brain hemorrhage is a serious complication and has a high mortality rate. It is important and positive of reducing bleeding, maintaining hemodynamics and environmental stability to avoid the large blood transfusion and infusion for the prevention of serious complications.