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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。
Objective To investigate the prevention and treatment of neuropsychiatric complications after orthotopic liver transplantation. Methods The clinical data of 516 patients with the same type of orthotopic liver transplantation who underwent neuropsychiatric system in the First Affiliated Hospital of Sun Yat - sen University from January 2004 to December 2006 were analyzed retrospectively. Results 83 patients (16.1%) had neuropsychiatric complications, including 67 diffuse encephalopathy (13.0%), cerebrovascular accident (1.6%), seizure in 7 patients (1.4%), central pontine myelinolysis 2 cases (0.4%), 2 cases (0.4%) of central nervous system infection, some cases complicated by two or more complications, including 7 cases of seizures and 3 cases of intracranial hemorrhage. Respectively, taken a combination of etiological treatment and symptomatic treatment of integrated control measures, including 7 cases of encephalopathy patients with continuous replacement of artificial liver, 2 cases of intracranial hemorrhage in patients underwent craniotomy hematoma. Of the 83 patients, 12 died, with a mortality rate of 14.5% (12/83) associated with postoperative neuropsychiatric complications. Conclusions The incidence of neuropsychiatric complications after liver transplantation is high, and the clinical manifestations are diverse. The occurrence of intracranial hemorrhage and central nervous system infections often indicate poor prognosis. The emphasis is on perioperative prevention and comprehensive treatment and adjustment for etiology Immunosuppressive drugs can reduce mortality.