肝移植术后神经精神并发症的回顾分析

目的:回顾性分析60例肝移植受体术后神经精神并发症的诊治情况。方法:分析2001年4月至2003年8月60例肝脏移植者术后神经精神并发症的发生、病因、治疗反应及预后情况。结果:60例病人中21例(共23例次)曾有神经精神并发症表现。总发生率为38.3%。其中谵妄样精神障碍15例次(28.3%),癫痫2例(3.3%),昏迷2例(3.3%),肢体运动障碍1例(1.7%),颅内感染引起的头痛、呕吐1例(1.7%)。药物、脑出血、脑梗死、全身感染、颅内感染是相关的病因。16例谵妄样精神障碍及2例脑出血发生在术后1周内,1例颅内真菌感染发生在术后第6月。大部分并发症的治疗反应较好,而脑出血则是严重的移植后中枢神经系统并发症,预后很差。结论:肝移植术后神经精神并发症的发生率较高,大多数病例症状较轻,预后较好,但严重的并发症则死亡率很高。大部分并发症发生在术后早期,也有部分发生在晚期。有多种病因或易感因素。针对不同病因和及时、有效的处理能改善此类病人的预后。

Retrospective Analysis of Neuropsychiatric Complications of Liver Transplantation

Objective: To review the experience in dealing with neuropsychiatric complications after orthotopic liver transplantation(OLT) in our first consecutive 60 OLT recipients. Methods: Between April 2002 and August 2003, 60 patients underwent OLT. Data on the incidence, time of onset, response to treatment and outcome of neuropsychiatric complications were analyzed. Results: Twenty-one patients among 60 patients had neuropsychiatric complications after OLT, resulting in an incidence of 35.0%. The incidence of encephalopathy was 28.3%; seizure, 3.3%; coma, 3.3%; limb dyskinesia, 1.7% and headache, vomiting induced by central nervous system infection, 1.7%. The use of immunosuppressive drugs, cerebral hemorrhage, cerebral infarct, systemic and infection were causative factors. Sixteen cases of encephalopathy and 2 cases of cerebral hemorrhage occurred during the first week, and one patient developed cryptococcal meningitis in 6 months after OLT. The prognosis of most patients with the complications was good, except serious cerebral hemorrhage. Conclusions: Neuropsychiatric complications after OLT are commonly seen after OLT; with the exception of seven cerebral hemorrhage, most of them carry a mild prognosis. Most complications occur early following OLT and a variety of etiology exists. Effective treatment specific for different etiology can help to improve the prognosis of such patients.