肝胆胰疾病术后代谢性脑病

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摘要

代谢性脑病(Metabolic Encephalopathy, ME)是一组由多种病因引起的中枢神经系统功能障碍疾病。根据病因可分为硫胺素缺乏引起的韦尼克脑病(WE)、肝硬化患者肝功能不全最终氨中毒引起的肝性脑病(HE)、低血钠导致血浆低渗引起的低钠血症性脑病、肾功能不全后毒素积聚引起的尿毒症性脑病(UE)、血糖波动过大引起的血糖异常性脑病。ME的病理生理机制不尽相同,但在临床表现上均表现出不同程度的神经精神症状。轻者表现为冷漠、易怒、时空感觉障碍、思维迟钝、智力下降等,重者表现为谵妄、嗜睡、昏迷。对于患有代谢性脑病的患者,治疗这种疾病对每个临床医生来说都不是一件容易的事情,但代谢性脑病的预防可能比治疗简单得多,而且回报也更大。
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Metabolic Encephalopathy After Surgery Hepatobiliary and Pancreatic Diseases
Metabolic Encephalopathy (ME) is a group of diseases with central nervous system dysfunction caused by a variety of etiologies. According to the etiology, it can be divided into Wernicker's encephalopathy (WE) caused by thiamine deficiency, hepatic encephalopathy (HE) caused by liver dysfunction and eventual ammonia poisoning in patients with cirrhosis, hyponatremic encephalopathy caused by plasma hypotonic due to low serum sodium, uremic encephalopathy (UE) caused by toxin accumulation after renal dysfunction, and dysglycemic encephalopathy caused by excessive blood glucose fluctuation. The pathophysiological mechanism of ME is not the same, but for the clinical symptoms, it all show different degrees of neuro-mental symptoms. The mild manifestations are indifference, irritability, time-space sensory disorders, thinking retardation, mental decline etc., and the serious manifestations are delirium, lethargy, coma. In patients with existing metabolic encephalopathy, treating the disease is not an easy task for every clinician, but prevention of metabolic encephalopathy may be much simpler and the return greater than treatment.
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