硫胺缺乏所致血液透析相关性脑病的临床分析

Clinical analysis of thiamine deficiency induced encephalopathy in hemodialysis patients

分析硫胺(维生素B1)缺乏所致血液透析相关性脑病的临床特征,并探讨其早期诊断与治疗方法。方法对10例临床诊断为硫胺缺乏所致血液透析相关性脑病患者的临床表现、治疗及疗效等进行临床分析。结果本组患者临床表现呈多样化,包括舞蹈病、快速进展性痴呆、肌阵挛、抽搐、意识模糊、嗜睡和昏迷等。10例中7例经肌肉注射维生素B1后病情缓解,3例死亡患者其维生素B1治疗均开始于脑病表现出现1周以后。所有病例均为伴有严重消化道症状的初次接受血透治疗的患者。结论血液透析病人出现难以解释的中枢神经系统表现时,应高度重视硫胺缺乏所致血液透析相关性脑病的发生,及时补充维生素B1及营养支持治疗可望缓解病情,否则可致患者可死亡。

Objective： To investigate the clinical features and early diagnosis and management of encephalopathy induced by thiamine de- ficiency （Wernicke＇s encephalopathy, WE） in hemodialysis patients. Methods： 10 patients with WE were included in this study. The clinical features, diagonosis and results of treatment were analyzed. Results： Manifestations included confusion, chorea, rapidly progressive dementia, myoclonus, convulsions, and coma. Intravenous thiamine was administered to these 10 patients. 7 patients recovered, but 3 patients failed to respond and died because of delayed treatment. Conclusions： We conclude that in hemodialysis patients, unexplained encephalopathy can be mainly attributed to thiamine deficiency. This condition is fatal if unrecognized and can be successfully treated with prompt thiamine replacement.