肝移植患者术后住院期间的中枢神经系统并发症

In-hospital central nervous system complications after liver transplantation

目的探讨肝移植术后住院期间中枢神经系统并发症的发病情况、临床和神经影像学特征及可能的危险因素及预后。方法对中山大学附属第一医院1996年1月至2005年6月间共337例患者的358次肝移植手术进行同顾性研究。结果术后住院期间患者出现中枢神经系统并发症共58例,发生率16.2%,病死率41.4%。最常见的表现为肝移植脑病(10.3%),次之为癫癎(4.5%)和脑血管疾病(2.8%)。与无中枢神经系统并发症的肝移植患者相比,术后发生巾枢神经系统并发症者的年龄、是否再次肝移植及病死率差异有统计学意义(P<0.05)。结论肝移植术后住院期间中枢神经系统并发症的发生率及病死率较高,直接影响患者的生活质量及预后。年龄偏大、冉次肝移植可能是其危险因素。

Objective To explore the incidence, clinical and neuroimaging features, possible risk factors and outcome of in-hospital central nervous system complications after orthotopic liver transplantation （OLT）. Methods 337 consecutive patients who underwent 358 OLTs at the first affiliated hospital, Sun Yet-Sen University during January 1996 through June 2005 were retrospectively analyzed, focusing on their clinical and neuroimaging features of the in-hospital central nervous system complications after OLT. The comparison of the possible risk factors and outcome was made between patients with or without central nervous system complications. Results Fifty-eight patients developed in-hospital central nervous system complications after OLT. The incidence was 16. 2% and the mortality rate was 41.4%. The most common central nervous system complication was encephalopathy （10. 3% ）, next was seizures （4. 5% ）. 10 patients （2. 8% ） had cerebralvascular complications （8 patients with cerebral hemorrhage and 2 with cerebral infarction）. Significant differences of age, retransplantation and the mortality rate existed between the patients with and without central nervous system complications. Conclusions There was a high incidence and mortality rate of in-hospital central nervous system complications after OLT, which had a impact on quality of life and outcome of patients underwent OLT. Age, retransplantation may be the possible risk factors of central nervous system complications after OLT.