胃肠道手术后并发韦尼克脑病患者的临床诊治分析

Clinical Diagnosis and Treatment of Wernicke Encephalopathy in Postoperative Patients Treated by Gastrointestinal Surgery

目的分析胃肠道手术后并发韦尼克脑病患者的临床诊治情况。方法回顾性分析2011年1月—2016年1月邯郸市人民医院收治的10例胃肠道术后并发韦尼克脑病患者的临床资料,包括性别、年龄、基础疾病、手术方式、术后并发症、治疗方法、临床症状和体征、实验室检查结果、诊断依据及转归。结果 10例患者术后10-25 d发生韦尼克脑病,平均时间为（15.2±5.1）d。8例患者早期出现中枢神经系统损伤症状,后期出现嗜睡、昏迷等意识障碍;5例患者出现眼球运动障碍、视力下降、眼肌震颤;3例患者出现站立及步态不稳等共济失调症状;2例患者出现典型＂三联征＂（眼球震颤、精神异常、共济失调）。实验室检查结果示电解质紊乱4例;既往无糖尿病史患者出现血糖升高1例;6例患者行脑电图检查示广泛性慢波活动增多;10例患者行颅脑MRI检查,其中8例提示乳头体缩小,丘脑内侧、第三脑室、第四脑室及中脑导水管周围出现双侧对称异常高信号,2例患者未见明显异常。以患者临床症状和体征、颅脑MRI检查结果及予以维生素B1治疗后转归情况作为韦尼克脑病的诊断依据。治疗后10例患者临床症状和体征均改善;出院后随访5-60个月,其中9例患者完全恢复且无复发,1例患者出现逆行性遗忘。结论胃肠道手术后患者易并发韦尼克脑病,临床应予以重视,同时应早期补充维生素B1以免出现不可逆性神经系统损伤。

Objective To analyze the clinical diagnosis and treatment of Wernicke encephalopathy in postoperative patients treated by gastrointestinal surgery. Methods A total of 10 postoperative patients treated by gastrointestinal surgery who complicated with Wernicke encephalopathy were selected in the People＇s Hospital of Handan from January 2011 to January 2016,and their clinical data was retrospectively analyzed, including gender, age, underlying disease, surgical procedures,postoperative complications,therapeutic regimen,clinical symptoms and signs,laboratory examination results,diagnostic basis and treatment outcome. Results The occurrence time of Wernicke encephalopathy was from 10 to 25 days after surgery,average at（ 15. 2 ± 5. 1） days. Of the 10 patients,8 cases occurred central nervous system injury symptoms at early stage,occurred disturbance of consciousness（ including somnolence and coma） at later stage; 5 cases occurred eyeball movement disorder,diminution of vision and eye muscle tremors; 3 cases occurred ataxia symptoms（ including unstable stand and unstable gait）; 2cases occurred typical triad syndrome（ including nystagmus,psychological problem and ataxia）. Laboratory examination results showed that,4 cases occurred electrolyte disturbance; 1 case occurred hyperglycemia without positive history of diabetes; 6cases received electroencephalogram examination and found generalized slow- wave activity increased; all of the 10 cases occurred craniocerebral MRI examination,thereinto 8 cases found shrink of corpus albicans and bilateral symmetrical abnormally high signal in medial thalamus,ventriculus tertius,ventriculus quartus and peripheral tissues of aqueduct of sylvius,the other 2cases did not found obvious abnormity. We take clinical symptoms and signs, craniocerebral MRI examination results and treatment outcome of vitamin B1 as the diagnostic basis of Wernicke encephalopathy. After 10 days of treatment,all of the 10patients＇ clinical symptoms and signs relived; after 5 to 60 months of follow- up,9 out of 10 patients got complete recovery without recurrence,the other 1 case occurred retrograde amnesia. Conclusion Postoperative patients treated by gastrointestinal surgery have high risk of Wernicke encephalopathy,that clinicians should pay more attentions to and timely use vitamin B1 at early stage to avoid the irreversible neurological damage.