Neurologic complications in liver transplantation
Neurologic complications in liver transplantation
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肝移植的神经系统并发症
DOI：
10.1111/j.1600-0404.1993.tb04070.x
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发表时间：
1993
影响因子：
3.5
通讯作者：
F. Colina
中科院分区：
文献类型：
--
作者：
E. Moreno;S. Gómez;I. Gonzalez;C. Loinaz;I. García;A. Pérez;C. Palomo;A. Alvarado;V. Maffettone;F. Pérez;C. Lumbreras;F. Colina
本文回顾性分析了143例连续成人肝移植患者（143例成人和18例儿童共208例肝移植）的神经系统并发症。143例患者中有19例（13.2%）在术后发生神经系统并发症。术中使用类固醇开始免疫抑制，第1天添加硫唑嘌呤，移植后第2天使用环孢素，通过RIA调整至400 - 600 ng/ml水平。硫唑嘌呤在第三个月停用。19名患者中有14名（73.6%）出现CNS并发症，其特征为：弥漫性多因素脑病（5例患者）;白质脑病（2例患者）需要暂时（1例）或永久（1例）停用环孢素A;出血（2例由于动脉高血压和凝血病，另1例由于不明原因）;继发于心跳呼吸骤停（2例患者）或动脉血栓形成（1例患者）的缺血/缺氧损伤;以及继发于骨质疏松症的椎体压缩（T10-T11）导致的脊髓病（1例患者）。最常使用的诊断检查是计算机断层扫描（CT）（85.7%）和脑电图（EEG）（42.8%）。19名患者中的5名（26.3%）发生周围神经系统（PNS）并发症：1例患者在麻醉期间因中心静脉插管导致可逆性Claude-Bernard-Horner综合征; 2例患者因手术室手术台支架压迫膝盖以下导致腓神经麻痹; 1例患者继发于长时间插管和中心静脉导管插入术的右侧喉返神经不可逆损伤; 1例患者在手术室中继发于上肢不可逆性过伸，造成左侧臂丛神经可逆性损伤。由于需要透析和腋静脉导管插入术进行静脉-静脉转流，14例中枢神经系统损害患者中有9例（9/14，64.2%）死亡。在5/9例（55.5%）死于CNS病变的患者中，神经系统病变（CNS出血和缺氧缺血性损伤）直接或间接导致死亡。严格控制患者在手术室中的体位、术后即刻的动脉高压和凝血障碍以及血清环孢素A水平将消除接受肝移植的患者的大多数神经系统并发症。
A retrospective review is presented of neurologic complications in our first 143 consecutive adult patients (208 liver transplants in 143 adults and 18 children) undergoing liver transplantation. Nineteen (13.2%) of the 143 patients developed neurologic complications in the postoperative period. Immunosuppression was initiated intraoperatively with steroids with the addition of azathioprine on Day 1 and cyclosporine, adjusted by RIA to a level of 400‐600 ng/ml, on Day 2 post‐transplantation. Azathioprine is discontinued in the third month. Fourteen of the 19 patients (73.6%) presented with CNS complications characterized by: diffuse multifactorial encephalopathy (5 patients); leukoencephalopathy (2 patients) which required temporary (1 case) or permanent (1 case) discontinuation of cyclosporine A; hemorrhage (in 2 cases due to arterial hypertension and coagulopathy and another due to unknown causes); ischemic/anoxic injury secondary to cardiorespiratory arrest (2 patients) or arteriothrombosis (1 patient); and myelopathy (1 patient) due to vertebral compression (T10‐T11) secondary to osteoporosis. The diagnostic studies most often employed were computed tomographic (CT) (85.7%) and electroencephalography (EEG) (42.8%). Five of 19 patients (26.3%) suffered peripheral nervous system (PNS) complications: 1 patient with reversible Claude‐Bernard‐Horner Syndrome caused by central venous catheterization during anesthesia: 2 patients with peroneal nerve palsy due to compression below the knees by operating room table supports; 1 patient with an irreversible lesion of the right recurrent laryngeal nerve secondary to prolonged intubation and central venous catheterization; and 1 patient with a reversible lesion of the left brachial plexus secondary to inadvertant hyperextension of the upper extremity on the O.R. table due to the need for dialysis and catheterization of the axillary vein for veno‐venous bypass. Nine of fourteen (9/14, 64.2%) of patients with CNS lesion died. In five of the nine patients (55.5%) who died with CNS lesion, the neurologic lesions (CNS hemorrhage and anoxic‐isquemic injury) were directly or indirectly responsable for death. Strict control of patient positioning in the operating room, arterial hypertension and coagulation disturbance in the immediate postoperative period and serum cyclosporine A levels would eliminate the majority of neurologic complications in patients undergoing liver transplantation.
DOI：
--
发表时间：
1990
期刊：
Surgery, gynecology & obstetrics
影响因子：
--
作者：
Lebeau,G;Yanaga,K;Marsh,JW;Tzakis,AG;Makowka,L;Gordon,RD;Todo,S;Stieber,AC;Iwatsuki,S;Starzl,TE
通讯作者：
Starzl,TE