肝移植术后神经精神系统并发症的预防和治疗

目的 探讨原位肝移植术后神经精神系统并发症的预防和治疗。方法 对2004年1月至2006年12月中山大学附属第一医院施行的516例同种原位肝移植病人神经精神系统并发症的临床资料进行回顾性分析。结果 全组神经精神系统并发症83例（16.1%），其中弥漫性脑病67例（13.0%），脑血管意外8例（1.6%），癫痫发作7例（1.4%），脑桥中央髓鞘溶解症2例（0.4%），中枢神经系统感染2例（0.4%），部分病例合并两种以上并发症，包括7例癫痫发作中，3例合并颅内出血。分别采取了病因治疗和对症处理相结合的综合防治措施，其中有7例脑病病人给与持续的人工肝替代治疗，2例颅内出血病人施行了开颅血肿清除术。83例病人中，死亡12例，与术后神经精神系统并发症相关病死率为14.5%（12/83）。结论 肝移植术后神经精神系统并发症发生率较高，临床表现形式多样；颅内出血和中枢神经系统感染的发生多提示预后不良；重视围手术期的预防，及时采取针对病因的综合治疗和调整免疫抑制药物可降低病死率。

Prophylaxis and management of neuropsychiatric complications after liver transplantation

Prophylaxis and management of neuropsychiatric complications after liver transplantation MA Yi， TAI Qiang, HE Xiao-shun， et al. Departmentment of Transplantation Surgery，the First Affiliated Hospital of Sun Yat-sen University，Guangzhou 510080，China Corresponding author：MA Yi， E-mail：anhuimayi2002@163.com Objective To study the prophylaxis and management of neuropsychiatric complications after othotopic liver transplantation(OLTx). Methods The clinical data of 516 cases performed allograft othotopic liver transplantation from January 2004 to December 2006 at the First Affiliated Hospital of Sun Yat-sen University were collected and analyzed retrospectively. The incidence and course of neuropsychiatric complications after OLT were summarized. Results There were 83 cases had neuropsychiatric complications（16.1%）including 67 cases（13.0%） of diffuse encephalopathy, 8 cases（1.6%）of cerebrovascular accident, 7 cases（1.4%）of epileptic seizure （including 3 cases of intracranial hemorrhage）,2 cases（0.4%）of central pontine myelinolysis and 2 cases（0.4%）of central nervous system infection. Integrated control therapy of etiological treatment and symptomatic treatment were taken to treat neuropsychiatric complications. Seven cases of encephalopathy were administrated persistent artificial liver replacement therapy and 2 cases of intracranial hemorrhage were performed craniotomy hematoma clearance. Of the 83 cases, 12 cases died, and the neuropsychiatric complications related mortality was 14.5%（12/83）. Conclusion Neuropsychiatric complications after OLT are common and have plenty of clinical manifestations. The occurrence of intracranial hemorrhage and central nervous system infection always suggest unfavourable prognosis. Thinking highly of perioperative prevention, taking etiotropic combined therapy and adjusting immunosuppressive drug can decrease mortality conspicuously.