四川大学学报‘医学版?2007；38(3)JSichuanUniv(MedSciEdi：535—538、⋯‘，⋯V_’。肝移植术后严重中枢神经系统并发症的病因探讨李甫强，李波△，严律南，曾勇，文天夫赵纪春，张中伟，刘晓珑，杨猛，张广坛四川大学华西医院肝移植中心(成都610041)【摘要】目的探讨肝移植术后早期严重中枢神经系统并发症的种类、发病原因及防治措施。方法回顾性分析2001年7月至2006年7月实施的347例肝移植患者临床资料，比较分析肝移植后早期无神经系统并发症和有严重中枢神经系统并发症两组与原发疾病、血钠、血镁、血浆渗透压、凝血功能等的关系。结果347例肝脏移植患者中71例(20．46％)出现与移植相关的精神神经系统并发症，其中6例(1．73％)出现严重中枢神经系统并发症，包括脑水肿、脑出血、脑桥中央髓鞘溶解症(centralpontinemyelinolysis，CPM)，其中5例死亡。肝硬化失代偿、脾亢的患者术后严重中枢神经系统并发症发病率高。与无神经系统并发症组比较，脑出血患者术前均有脾亢、凝血功能不良明显；CPM和脑水肿患者移植前均存在严重的顽固性、慢性低钠血症，移植术前后48h内血钠及血浆渗透压变化明显。结论肝移植受体术后严重中枢神经系统并发症的发生与原发疾病有关，并可能与术前慢性低钠血症、围手术期血钠和血浆渗透压大幅波动、凝血功能未及时纠正有关。【关键词】肝移植脑水肿脑出血脑桥中央髓鞘溶解症低钠血症【中图分类号】R742．89ThePossibleCausesofSeriousCentralNervousSystemComplicationsOccurringafterLiverTransplantationL，Fu—qiang，L，Bo△，YANLii—nan，ZENGYong，WENTian一／k，ZHAOJi—chun，ZHANGZhong—wei，LIUXiao-long，YANGMeng，ZHANGGuang—tan．CenterofLiverTransplantation，WestChinaHospital，SichuanUniversity，Chengdu610041，China[Abstract]ObjectiveTostudytheclassification，possiblecauses，cureandpreventionmeasuresofseriouscentralnervoussystem(CNS)complicationsoccurringearlyfollowinglivertransplantation．MethodsTheclinicalmaterialrecordsof347patientsundergoingtheorthotopiclivertransplantationfromJuly2001toJuly2006wereanalyzedretrospectively．TheperioperationriskfactorsofCNScomplications，whichmightbetheprimaryliverdisease，serumsodiumlevel，magnesiumlevel，fluctuationdegreeofplasmaosmolalityandserumsodium，functionofbloodclotting，etc．，wereanalyzedbetweenpatientswithseriousCNScomplicationsandwithoutneurologicalcomplications．ResultsAtotalof71(20．46％)neurologicalsymptomsappearedin347postoperativepatientswhoincluded6cases(1．73％)withseriousCNScomplicationssuchascerebraledema，cerebralhemorrhageandcentralpontinemyelinolysis，andof6cases，5patientsdied．ThemorbidityofearlyseriouscomplicationsofCNSwashigherinpatientswithdecompensatecirrhosisand／orhypersplenism．Comparedwiththegroupofnoneurologicalcomplications，tWOpatientswithcerebralhemorrhagesufferedfrompreoperativehypersplenismandworsedysfunctionofbloodclotting(P<0．05)；patientswithdevelopedCPMandcerebraloedemahadserioushyponatremiahistorybeforeoperation，andintenselyfluctuatedplasmaosmolalityshowedbeforeandafteroperation．ConchsionTheonsetofseriouscomplicationsofCNSinrecipientsoflivertransplantationmaybeintimatelyrelatedtotheprimaryliverdisease，andbeassociatedwithchronichyponatremia，rapidcorrectionofserumsodiumconcentration，intenseincreaseofplasmaosmolalityandnopromptrectificationofthefunctionofbloodclottingduringperioperation．【Keywords]LivertransplantationCerebraloedemaCerebralhemorrhageCentralpontinemyelinolysis(CPM)Hyponatremia肝移植是目前各种终末期肝病及肝功能衰竭唯一有效的治疗手段，然而，肝移植术后神经系统并发症的发生率为7％～47％，大多发生在移植后的一△Correspondingauthor，E—mail：cdlipo@yahoo．co...
