肝移植术后颅内出血的防治

目的 总结肝移植术后颅内出血临床特点，探讨其原因、预防和治疗措施。方法 对我院从2003年10月到2005年5月的肝移植病例进行同顾性分析。结果 为395例病人做了406次肝移植。7例颅内出血，发病率1．8％（7／395）。发生时间2周内5例，1例治愈；29天和40天各1例，均治愈，死亡率57．1％（4／7）。6例病人存在凝血功能障碍，3例高血压，3例术中出血大于15000mL。结论 颅内出血是肝移植术后近期的常见死亡原因之一。颅内出血原因是多因素的，应采用减少术中出血、纠正凝血功能障碍、控制血压、抗菌素治疗和开颅手术等综合防治措施。

Prevention and treatment of intracranial hemorrhage after liver transplantation

Objective To sum up the clinic characteristics of intracranial hemorrhage after liver transplantation, and investigate the causes, prevention and treatment. Methods A retrospective study was performed in the cases with intracranial hemorrhage after liver transplantation from October 2003 to May 2005 in the third affiliated hospital of Sun Yat-sen University. Results 406 liver transplantations were performed in 395 patients. 7 cases (1.8%) suffered from intracranial hemorrhage, 5 within 2 weeks (1 was cured), the other 2 within 29 d and 40 d respectively; among them, 4 died, mortality rate 57.1%. 6 appeared to have thrombocytopenia or coagulopathies, 3 hypertension,3 intraoperative bleeding (>15,000mL). Conclusion Intracranial hemorrhage is one of the most deathful complications at the early stage after liver transplantation. A multitude of factors can cause intracranial hemorrhage after liver transplantation. Integrated prevention and treatment, including lessening intraoperative bleeding,correcting coagulopathy, controlling blood pressure, antibiotic therapy, and possibly early neurosurgical intervention, will be actively adopted.