腹部大手术后并发韦尼克脑病10例临床诊治分析

目的探讨腹部大手术后患者并发韦尼克脑病的临床特征及诊治方法。方法回顾性分析浙江省人民医院2000-2012年间腹部大手术后并发韦尼克脑病的10例患者的临床资料。结果10例患者发病时间为术后5-36（平均22．9）d。主要临床表现为头晕、嗜睡、意识障碍、视物模糊及步态不稳。MR检查主要表现为丘脑、第三脑室、侧脑室或中脑导水管周围等区域可见对称性长T1和T2信号。给予维生素B1治疗后，症状完全缓解6例，部分缓解2例，死亡2例。结论对于腹部大手术后需长期禁食的患者，外科医师需警惕并发韦尼克脑病，早期发现并及时补充维生素B1，可避免不可逆性脑损伤。

Clinical analysis of 10 patients with Wernicke encephalopathy after major abdominal surgery

Objective To explore the pathogenesis, clinical features, diagnosis and treatment of Wernicke encephalopathy after major abdominal surgery. Methods Clinical data of 10 patients with Wernicke encephalopathy after major abdominal surgery in the Zhejiang Provincial People＇s Hospital from 2000 to 2012 were retrospectively analyzed. Results Wernieke encephalopathy occurred during 5 to 36 days （mean 22.9 days） after surgery. The main symptoms included vertigo, vagueness, blurred vision, and gait inco0rdination. MRI showed bilaterally symmetrical enhancement of T1 and T2 signal in thalamus, third ventricle, lateral ventricle and periaqueductal region. With treatment of vitamin B1, 6 patients were completely recovered, and 2 partly recovered, but 2 died. Conclusions Surgeons should be aware of Wernicke eneephalopathy when treating patients undergoing major abdominal operation who need prolonged fasting postoperatively. Early detection and timely supplement of vitamin B1 can avoid irreversible brain damage.