肝移植患者术后早期精神并发症28例临床分析

Clinical analysis of psychiatric complications in early period after liver transplantation

目的探讨肝移植术后早期精神并发症的病因及防治措施。方法回顾性分析28例肝移植术后发生精神并发症患者的临床资料。结果 28例精神并发症患者表现为躁狂12例(43%),焦虑伴失眠(睡眠障碍)7例(25%),抑郁3例(11%),恐惧2例(7%),癫2例(7%),幻觉1例(4%),自杀倾向1例(4%)。11例躁狂患者在减少抗排斥药物及小剂量使用抗精神病药物(奥氮平、氟哌啶醇)后症状缓解,未见后遗症,另1例给予氟哌啶醇后出现抑郁状态,随着肝功能的逐渐恢复而好转。1例恐惧患者经医师及家属耐心劝导并给予镇静治疗后逐渐缓解。2例癫患者经头颅CT检查未见异常,在停用抗生素后逐渐好转。3例焦虑伴失眠患者经血培养证实合并败血症,焦虑症状日益严重,给予抗菌和镇静治疗后仍效果不佳,终因多脏器功能衰竭于术后2周内死亡。余患者均在2～3周内随着肝功能的逐渐好转,精神症状逐渐消失。结论肝移植术后早期精神并发症可能由患者自身因素,手术、环境及药物等因素引起,大部分症状较轻,预后良好,但精神症状严重者或并存器质性病变者病死率较高。针对不同病因及时进行治疗有助于改善患者的预后。

Objective To explore the etiology and treatment of psychiatric complications in early period after liver transplantation.Methods The clinical data of 28 patients combined psychiatric complications who underwent liver transplantation were analyzed retrospectively.Results Twenty-eight patients had psychiatric complications,mania 12 cases（43%）;angst and insomnia 7 cases（25%）;depression 3 cases（11%）;horror 2 cases（7%）;seizure 2 cases（7%）;hallucinosis 1 case（4%）,suicidal tendency 1 case（4%）.Eleven cases of mania presented symptomatic relief by diminished immunosuppressive drugs and used low dose antipsychotic（olanzapine,haloperidol）,there was no residual.When haloperidol was used,depressive state was appeared in one case presented as mania and relived gradually when liver function improved.When persuasion was given by dependents and physicians and sedation management was used,one case presented as horror relieved gradually.Two cases of seizure relieved gradually by withdrawal antibiotic,which nothing was abnormal by cranium computer tomography.Three cases with serious angst and insomnia diagnosed septemia by hemoculture,antibacterial and sedation therapies were given but had not good effectiveness,and were died in 2 weeks after operation.With the liver function improved,psychiatric symptom in the other cases disappeared gradually.Conclusion The early psychiatric complications after liver transplantation may result from self factor of patients,operation factor,the change of environment after operation,the use of drug and so on.Most of them have mild symptom and eusemia.But the patients with serious psychiatric or organic disease have high fatality rate.Effective treatment for different etiology can help to improve the prognosis of such patients.