肝移植术后主要神经系统并发症的发生和治疗

目的 观察肝移植术后主要神经系统并发症的类型及临床表现,并探讨其病因、易发因素及防治策略.方法 回顾性分析2003年10月至2005年9月完成的467例肝移植患者的临床资料,对肝移植术后出现神经系统并发症的病例进行统计分析并结合文献进行讨论.结果 共有91例(19.49%)患者发生神经系统并发症,其中弥漫性脑病72例,脑血管意外12例,癫痫发作4例,脑桥中央髓鞘溶解症3例,中枢神经系统感染2例.高龄、术前高胆红素血症、高渗透压、低血小板、肺部严重感染与弥漫性脑病密切相关.5例脑病患者施行了持续的肾脏替代治疗,8例脑出血患者中5例施行了开颅血肿清除术.出现神经系统并发症的患者中有79例痊愈,12例死亡,与神经系统相关死亡率为10.98%.结论 神经系统病变是肝移植术后常见并具有潜在危险的并发症,产生的原因是多因素的,免疫抑制剂的神经毒性只是一个促进因素.脑出血的发生多提示预后不良,针对病因的综合治疗和免疫抑制剂的及时调整有利于改善预后.

Major neurological complications following liver transplantation and their management

Objective To study the clinical features, underlying mechanism and management of major neurological complications following liver transplantation. Methods The data of 467 patients undergoing liver transplantation from Oct. 2003 to Sep. 2005 were retrospectively reviewed. Results Neurological complications occurred in 91 (19.49%) cases. The most common neurological complications were encephalopathy (72 cases), followed by stroke (12 cases), seizure (4 cases), central pontine myelinolysis (3 cases), and central nervous system infections (2 cases). Five encephalopathy cases were treated with continuous renal replacement and 5 intracranial hemorrhage cases with neurosurgical intervention. The mortality related to neurological complications was 10.98% (12/91). Conclusions Neurological complications are common and potentially fatal following liver transplantation involving several factors. CsA and FK506 may play an important role in the onset of neurological complications, and stroke, especially intracranial hemorrhage, has a high mortality. Combined therapies and timely modulation of the immunsuppressive regimens may improve the patient's outcome.