胃肠道手术后患者并发韦尼克脑病的临床分析

Wernicke encephalopathy after gastrointestinal surgery：Clinical analysis of 11 cases

目的探讨胃肠道手术后患者并发韦尼克脑病的临床特点、诊断及治疗方法。方法回顾性分析华中科技大学同济医学院附属协和医院2008年1月至2013年5月诊治的11例胃肠外科术后并发韦尼克脑病患者的临床资料。结果本组11例胃肠外科术后伴发韦尼克脑病患者均存在维生素B1缺乏的病因，9例伴有消化道漏、肠梗阻等严重术后并发症，发病时间为术后9—23d，平均（15±4）d。临床表现为中枢神经系统损害9例，眼征5例，共济失调4例。7例出现MRI特征性表现。给予大剂量维生素B1治疗后症状完全缓解9例，部分缓解2例。结论对胃肠道手术后长期禁食的患者需要警惕并发韦尼克脑病，围手术期补充足量维生素B1是预防及治疗韦尼克脑病的关键。

Objective To explore the clinical manifestations, diagnosis and treatment of Wernicke encephalopathy afte^r gastrointestinal surgery. Methods A retrospective study was performed on 11 patients with Wernicke enccphalopathy after gastrointestinal surgery in Wuhan Union Hospital from January 2008 to May 2013. Results All the 11 patients had the definite history of deficient vitamin B1 intake, following severe postoperative complications in 9 cases. Wernicke encephalopathy occurred 9 to 23 days （mean 15 ＋ 4 days） after surgery. The clinical manifestations included mental or memory impairment （9 cases）, eye signs （5 cases ）, cerebellar dysfunction （4 cases ）. 7 patients had characteristic manifestations on MRI examination. 9 patients were completely recovered and 2 were relieved after supplement of vitamin B1. Conclusions Surgeons should be on the alert against Wernicke encephalopathy in postoperative patients especially those suffering from complications and enough vitamin B1 supplement during the perioperative period is the key to prevent and treat Wernicke encephalopathy.