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肝移植术后脑桥外和脑桥中央髓鞘溶解症——附8例报告

赵凯 刘懿禾 于立新 王峪 刘蕾

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肝移植术后脑桥外和脑桥中央髓鞘溶解症——附8例报告

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  • 中图分类号: R657.3;R744

Central pontine and extrapontine myelinolysis following liver transplantation

  • 摘要: 目的探讨肝移植术后脑桥外和脑桥髓鞘溶解症的发病机制、临床表现和预后。方法回顾性分析8例肝移植术后发生脑桥外和脑桥髓鞘溶解症患者临床诊治经过和预后。结果本组患者肝移植术后3~11 d发生失语、吞咽困难、癫痫、昏迷,头部MRI提示脑干、基底节、脑叶脱髓鞘改变,经治疗后2例神志清楚但存在智力障碍,4例仍昏迷,2例因并发多器官功能衰竭死亡。结论围手术期血浆渗透压的显著波动是移植术后脑桥外和脑桥髓鞘溶解症的主要病因,临床表现为术后早期发生失语、吞咽困难、癫痫、昏迷等神经系统症状,头部MRI提示脑干、基底节、脑叶脱髓鞘改变,治疗上以脏器功能支持为主,血浆置换联合免疫球蛋白治疗可以改善预后。

     

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  • 出版日期:  2011-07-20
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