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目的探讨老年胃癌患者围手术期并发Wernicke脑病的发病机理、临床表现及诊断和防治措施。方法回顾性分析1990年10月至2009年12月期间,兰州军区兰州总医院普通外科收治的237例老年胃癌患者中,围手术期并发Wernicke脑病的7例患者的临床资料,总结其临床表现、辅助检查、诊断、治疗和预后情况,并分析与其发生有关的因素。结果本组病例临床表现为眼球震颤7例,共济失调4例,大脑功能紊乱6例,贫血4例。辅助检查:血生化指标异常7例,尿酮体阳性5例,血维生素B1含量减低2例,头颅MRI检查异常1例;治疗前确诊5例,经试验性治疗后确诊2例。4例治愈,1例明显好转,1例好转,1例死亡。术前合并低蛋白血症或幽门梗阻以及术后出现肠瘘或胃瘫综合征者,其Wernicke脑病发生率明显高于无合并症和并发症者(P<0.05)。结论 Wernicke脑病临床表现无特异性,诊断较困难,需引起临床医师重视,可联合多种方法进行诊断。围手术期及时改善或防治合并症和并发症,并补充足量B族维生素是重要的预防和治疗措施。
Objective To investigate the pathogenesis, clinical manifestation, diagnosis, prevention and treatment of perioperative Wernicke encephalopathy in elderly patients with gastric cancer. Methods The clinical data of 7 patients with Wernicke’s encephalopathy during the perioperative period were retrospectively analyzed from October 1990 to December 2009 in Lanzhou General Hospital of Lanzhou General Hospital. The clinical data of 237 patients with gastric cancer were retrospectively analyzed. The clinical manifestations, Assisted examination, diagnosis, treatment and prognosis, and analyze the factors related to its occurrence. Results The clinical manifestations of this group were nystagmus in 7 cases, ataxia in 4 cases, brain dysfunction in 6 cases and anemia in 4 cases. Auxiliary examination: blood biochemical abnormalities in 7 cases, urine ketone body positive in 5 cases, blood vitamin B1 decreased in 2 cases, head MRI abnormalities in 1 case; 5 cases diagnosed before treatment, confirmed by experimental treatment in 2 cases. 4 cases were cured, 1 case improved significantly, 1 case improved, 1 case died. Preoperative combination of hypoproteinemia or pyloric obstruction and postoperative intestinal fistula or gastroparesis syndrome, the incidence of Wernicke encephalopathy was significantly higher than those without complications and complications (P <0.05). Conclusion The clinical manifestation of Wernicke encephalopathy is nonspecific. It is difficult to diagnose. It needs to be paid more attention by clinicians and can be diagnosed by a variety of methods. Perioperative timely improvement or prevention of complications and complications, and add enough B vitamins is an important preventive and therapeutic measures.