重症肝病肝移植术后脑桥中央髓鞘溶解症的临床分析

Clinical analysis of 4 cases of central pontine myelinolysis occurring after liver transplantation

目的探讨重症肝病肝移植术后早期出现脑桥中央髓鞘溶解症的发病原因及临床特征。方法对890例重症肝病肝移植患者临床资料进行分析，从而研究出中央髓鞘溶解症的发生率，并从临床分析中寻找中央髓鞘溶解症的可能原因。结果年龄在39。57岁的890例患者中有4例术后3～9d发生脑桥中央髓鞘溶解症，并且其中一例死亡。这4例的手术时间为（566±56）min。4例患者的肝和肾等功能障碍在手术前、后是处在不同程度并表现了相应的症状，如意识障碍，失语，颅神经受累，肢体运动障碍，精神和行为障碍。有3例纠正低钠血症血液中钠的波动范围在48h〉18mmol／L。结论肝功能，手术时问长，血浆渗透压急剧变化，是肝移植术后CPM的因素。

Objective To study the possible causes and clinical features of central pontine myelinolysis （CPM） occurring after liver transplantation . Methods 890 patients with severe liver diseases underwent liver transplantation. Their clinical data were analyzed to investigate the incidence of CPM and the clinical manifestations and possible causes of CPM. Results Four of the 890 patients, aged 39-57, suffered from CPM 3-9 days after the liver transplantation and 1 of them died. The operation time of the 4 cases was （566±56） minutes. All 4 cases showed liver and renal dysfunction at different degrees before the operation. Symptoms, such as disturbance of consciousness, aphasia, cranial nerve involvement, obstacle of limb movement, and mental and behavior disorders were seen. The fluctuation range of blood sodium in correction of hyponatremia during 48 h was 〉18 mmol/L in 3 cases. Conclusion Underlying liver function, long operation time, and abrupt change of plasma osmolality, is the factors of CPM after liver transplantation.