肝移植术后早期并发颅内出血

Intracranial hemorrhage followed liver transplantation

目的研究肝移植术后并发颅内出血的发病情况、临床和神经影像学特征并探讨可能的危险因素及预后。方法回顾性分析337例、共358次肝移植病例中术后并发颅内出血的临床及神经影像学特征,并与同时期未发生颅内出血的肝移植病例进行比较,探讨其可能的危险因素及预后。结果术后发生颅内出血共8例(2.2%),死亡5例。临床表现为不同程度意识障碍、头痛、失语、偏瘫、呕吐、癫发作等。其头颅CT特点为出血量大、多部位、广泛性出血、以大脑半球实质内出血居多、血肿形状不规则、血肿易扩大或再次出血。术后并发颅内出血的患者年龄、术中低血压、合并细菌或真菌感染及病死率与无颅内出血的肝移植患者相比,差异具有统计学意义(P<0.05)。结论颅内出血是肝移植术后直接影响患者预后的一种严重神经系统并发症。年龄偏大、术中低血压及术后合并感染可能是肝移植术后并发颅内出血的危险因素。

Objective To explore the incidence, clinical and neuroimaging features, possible risk factors and outcome of intracranial hemorrhage after orthotopic liver transplantation （OLT）. Methods We retrospectively reviewed 337 consecutive patients who underwent 358 OLT.s in our hospital between January 1, 1996 and June 30, 2005, focused on the clinical and neuroimaging features of the patients with intracranial hemorrhage, and analyzed the possible risk factors and outcome by comparing patients with and without intracranial hemorrhage. Results 8 patients developed intracranial hemorrhage after OLT. The incidence was 2.2% and five of them died. These patients had different symptoms such as unconsciousness, headache, aphasia, hemiparesis, vomiting, seizures, and so on. Brain CT scans showed the features of the patients with intracranial hemorrhage as follow： massive, irregular, multiple and diffuse hematomas, most located at brain lobe and left hemisphere and may enlarge or rebleed. Significant difference was found in age, introperative hypotension, systemic infections and mortality rate between the patients with and without intracranial hemorrhage after OLT. Conclusions Intracranial hemorrhage had a direct impact on the outcome of patients underwent OLT. Age, introperative hypotension and systemic infections may be correlated with this complication.