肝移植术后并发桥脑中央髓鞘溶解症三例

目的 总结肝移植术后并发桥脑中央髓鞘溶解症(CPM)的诊治体会.方法 3例肝移植受者术后并发CPM,术前血清Na+明显偏低,分别为124 mmol/L、I 19 mmol/L和119 mmol/L,术后出现自主言语较少、自主动作变缓慢、吐词不清、昏迷等症状,经头颅磁共振(MRI)检查,例1主要表现为闭锁综合征,例2、3主要表现为昏迷.例I采取静脉给予大剂量丙种球蛋白治疗,例2采取高压氧治疗,例3未能进行针对性治疗.结果 3例患者术后均出现血钠快速升高,幅度达22～34mmol/L.例1术后随访3个月,基本恢复正常,但行动反应仍迟缓,肝功能正常.例2术后随访6个月,患者仍呈昏迷状态,肝功能良好.例3术后意识障碍逐渐加重,后死于肺部感染.结论CPM是肝移植术后的严重并发症,尚无有效的治疗方法 ,患者的预后差.

Central pontine myelinolysis following liver transplantation: clinical report of 3 cases

Objective To summarize the clinical experience of central pontine myelin-olysis after liver transplantation. Methods The clinical data of 3 patients diagnosed as having central pontinemyelinolysis following liver transplantation were reviewed. Three patients had obviously preoperativehyponatremia, and the levels of serum sodium were separately 124, 119 and 119 mmol/L. The firstpatient with lock-in syndrome received large dosage of immunog lobulin; The second and the thirdpatients had coma, and the third patients received hyperbaric oxygen treatment. Results The levels ofserum sodium in 3 patients were risen sharply. The first patient had been recovery nearly after 3months, the second patient had been no return in 6 months, and the third patient was died frompulmonary infection. Conclusion Central pontine myelinolysis threatened the patients' life followingliver transplantation seriously.