Bronster D J, Emre S, Mor E, Sheiner P, Miller C M, Schwartz M E
Department of Neurology, Mount Sinai Medical Center, New York, NY 10029-6574.
Mt Sinai J Med. 1994 Jan;61(1):63-9.
Neurologic complications are frequent after liver transplantation and are the cause of significant morbidity and mortality. A substantial proportion of the neurologic complications encountered after transplant is iatrogenic--the consequence of the harsh therapeutic interventions required to maintain function of the transplanted liver. The preoperative condition of the patient is also a major determinant of the incidence and impact of neurologic complications, as is the occurrence of poor early graft function or of repeated rejection episodes that require augmented immunosuppression. By recognizing the early signs of drug-related neurotoxicity, it is often possible to preempt the development of more severe trouble. Careful perioperative fluid management, specifically related to sodium and glucose levels, may reduce the risk of CPM. As effective treatment modalities have emerged, an aggressive approach to the diagnosis of central nervous system infection has assumed increased importance. With persistent attention to the details of basic patient care as well as to the specific neurologic diagnosis, and with a commitment to intensive rehabilitation therapy, the large majority of patients who suffer neurologic complications after transplant can ultimately return to a productive life.
肝移植后神经并发症很常见，是导致显著发病率和死亡率的原因。移植后遇到的相当一部分神经并发症是医源性的——是维持移植肝功能所需的严厉治疗干预的结果。患者的术前状况也是神经并发症发生率和影响的主要决定因素，早期移植物功能不良或需要增加免疫抑制的反复排斥反应的发生也是如此。通过识别药物相关神经毒性的早期迹象，通常有可能预防更严重问题的发展。精心的围手术期液体管理，特别是与钠和葡萄糖水平相关的管理，可能会降低渗透性脱髓鞘综合征的风险。随着有效治疗方式的出现，积极诊断中枢神经系统感染变得越来越重要。持续关注基本患者护理细节以及具体的神经诊断，并致力于强化康复治疗，大多数肝移植后出现神经并发症的患者最终能够恢复有意义的生活。
