肝移植后并发桥脑中央髓鞘溶解症三例

Central pontine myelinolysis after liver transplantation: report of three cases

目的总结肝移植后并发桥脑中央髓鞘溶解症(CPM)的诊治体会。方法回顾性分析3例肝移植后并发CPM的临床资料。结果例1于术后第18d出现定向障碍、四肢抽搐,随之昏迷,症状出现前后血电解质在正常范围;例2于术后第6d出现昏迷,有明显的低钠血症;例3于术后第7d出现意识模糊、被害妄想,随之昏迷,症状出现前后血电解质在正常范围。3例患者均经头颅磁共振检查诊断为CPM,虽经积极治疗,但最后均死亡。结论肝移植后并发CPM的原因是多方面的,其预后差,病死率高;磁共振是诊断CPM的首选方法。

Objective To summarize the clinical experience of central pontine myelinolysis (CPM) after liver transplantation.Methods The clinical data of three cases of CPM after liver transplantation in our hospital were analyzed retrospectively.Results The first case manifested disorientation, clonic jerks in all limbs, and soon fell into coma on 18th day after liver transplantation. No (obvious) electrolyte abnormality was observed before and after the symptom. The second one presented with coma on 6th day after operation, who had hyponatremial history record before coma attack. The third one developed confusion, delusion of persecution and coma on 7th after transplantation. The blood electrolyte was at the normal range before and after the symptom occurred. All the three cases were diagnosed as CPM by magnetic resonance image (MRI) and died in the end.Conclusion CPM is a multifactorial progress and the mortality rat is high. MRI is the first choice in the diagnosis of it.