腹部手术后并发韦尼克脑病四例诊治分析

Diagnosis and Treatment of Wernicke Encephalopathy after Abdominal Surgery:Report of Four Cases

目的韦尼克脑病易被临床医师漏诊,尤其在腹部手术后的患者中更易被忽视,故本文在于加深临床外科医生对该病的认识,提高早期诊断率。方法回顾性分析4例腹部手术后并发韦尼克脑病患者的资料,包括临床特点、使用维生素B1治疗的效果及预后。结果韦尼克脑病是由于维生素B1缺乏所致的严重营养代谢性脑病,典型临床表现为眼肌麻痹、共济失调、意识及精神障碍三联征。其诊断依据临床表现、使用维生素B1后的疗效,颅脑MRI特异性征象。如能在疾病早期注意补充足量的维生素B1则病情能明显改善。结论外科医生必须提防韦尼克脑病,尤其对于腹部手术后长期不能进食的患者,当疑诊为韦尼克脑病时应尽早补充维生素B1以避免不可逆性脑损伤。

Objective Wernicke′s encephalopathy（WE） is prone to be underestimated in clinical practice,especially in patients after abdominal surgery.This article aims to improve the awareness of this disease among surgeons with the hope to raise the early diagnosis rate.Methods Clinical data including clinical features,curative effects of thiamine,and prognosis of 4 WE cases were analyzed retrospectively.Results WE is a severe metabolic encephalopathy of thiamine deficiency and is characterized by acute mental confusion,ataxia,and ophthalmoplegia.The diagnosis of WE is based on clinical signs,curative effects of thiamine and cranial MRI findings.The conditions can be remarkably improved by early supplement of thiamine before the onset of irreversible brain damage.Conclusion Surgeons should be aware of the possibility of acute WE and supplementary thiamine should be delivered to post-abdominal surgery patients as soon as possible when WE is suspected so as to alleviate or prevent irreversible brain damage.