非酒精中毒性Wernicke脑病的临床分析
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摘要
目的探讨非酒精中毒性Wernicke脑病的病因、诊治及临床特点。方法回顾性分析郑州大学第二附属医院2015-01—2018-01行腹部手术后并发Wernicke脑病患者8例的临床资料。结果本组8例患者中男7例,女1例,平均年龄54.25(29~72)岁,发病时间为术后8~21(15.75±4.13)d,其中重症胰腺炎行胰腺坏死组织清创引流术后4例,术后出现言语含糊、表情淡漠、意识混乱、谵妄等精神症状;因"消化道肿瘤"行胃肠道肿瘤根治术4例,术后出现注意力不集中、谵妄等精神症状,均经神经内科会诊并行磁共振检查确诊为Wernicke脑病,本组所有患者及时诊断后经维生素B_1肌内注射、纠正电解质紊乱治疗后,7例症状完全缓解,1例死亡。结论腹部手术后因长期肠外营养导致维生素B_1摄入不足,腹部手术患者围术期常规给予维生素B_1摄入是预防和治疗Wernicke脑病的关键。
Objective To explore the etiology,diagnosis,treatment and clinical characteristics of non-alcoholic wernicke brain disease.Methods The clinical data of 8 patients with wernicke brain disease after abdominal surgery in the Second Affiliated Hospital of Zhengzhou University in recent 3 years were retrospectively analyzed.Results 8 cases of patients,7 male and female in1 case,average age 54.25(29-72),the onset time of postoperative 8-21 d(average 15.75±4.13),including 4 cases of severe acute pancreatitis after drainage of pancreatic necrotic tissue debridement surgery,postoperative appear vague and expression apathy,confusion,delirium and other mental symptoms;The other 4 patients for postoperative patients with gastrointestinal tract,postoperative symptoms of inattention,delirium spirit,both by neurology consultation parallel mri diagnosis of wernicke encephalopathy,this group of all of the patients after timely diagnosis by vitamin B_1 intramuscular injection,correct electrolyte disorder after treatment,7 cases symptoms completely,1 case died.Conclusion After abdominal surgery,due to long-term enteral nutrition,the intake of vitamin B_1 is insufficient.It is the key to prevent and treat wernicke brain disease that patients with abdominal surgery are routinely given vitamin B_1 during perioperative period.
Objective To explore the etiology,diagnosis,treatment and clinical characteristics of non-alcoholic wernicke brain disease.Methods The clinical data of 8 patients with wernicke brain disease after abdominal surgery in the Second Affiliated Hospital of Zhengzhou University in recent 3 years were retrospectively analyzed.Results 8 cases of patients,7 male and female in1 case,average age 54.25(29-72),the onset time of postoperative 8-21 d(average 15.75±4.13),including 4 cases of severe acute pancreatitis after drainage of pancreatic necrotic tissue debridement surgery,postoperative appear vague and expression apathy,confusion,delirium and other mental symptoms;The other 4 patients for postoperative patients with gastrointestinal tract,postoperative symptoms of inattention,delirium spirit,both by neurology consultation parallel mri diagnosis of wernicke encephalopathy,this group of all of the patients after timely diagnosis by vitamin B_1 intramuscular injection,correct electrolyte disorder after treatment,7 cases symptoms completely,1 case died.Conclusion After abdominal surgery,due to long-term enteral nutrition,the intake of vitamin B_1 is insufficient.It is the key to prevent and treat wernicke brain disease that patients with abdominal surgery are routinely given vitamin B_1 during perioperative period.
引文
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[13]FALCO A D,SIMONE M D,SPITALERI D,et al.Non-alcoholic Wernicke-Korsakoff syndrome heralding non-Hodgkin lymphoma progression[J].Neurol Sci,2018,39:13.
[14]KOTHA V K,DE SOUZA A.Wernicke's encephalopathy followinghyperemesis gravidarum a report of three cases[J].Neuroradiol J,2013,26(1):35-40.
[15]JAN K.Wernicke encephalopathy:(MRI)picture worth a thousand words[J].Oxf Med Case Reports,2018,2018(5):omy013.
[16]TOTH A,ARADI G,VARALLYAY G.Wernicke's encephalopathy induced by the use of diet pills and unbalanced diet[J].Orv Hetil,2014,155(12):469-474.
[17]刘晓团,于博.结肠癌、肠梗阻术后并发Wernicke脑病原因分析[J].临床误诊误治,2014,27(8):71-72.
[18]KAMASAK T,KUL S,TUSAT M,et al.A Case of Wernicke Encephalopathy Developing After Ileal Bypass Surgery[J].Pediatr Emerg Care,2018:1.
[19]MILONE M,VELOTTI N,MUSELLA M.Wernicke Encephalopathy Following Laparoscopic Sleeve Gastrectomy-a Call to Evaluate Thiamine Deficiencies After Restrictive Bariatric Procedures[J].Obes Sur,2018,28(10):1-2.
[20]GAN Y C,JING J,QIU Z X,et al.Wernicke Encephalopathy in a Patient with Pulmonary and Abdominal Tuberculosis[J].Chin Med J,2017,130(22):2 757-2 758.
[21]ATHANASIOU A,SPARTALIS E,MORIS D,et al.Sleeve Gastrectomy and Wernicke Encephalopathy[J].Am J Ther,2016,24(4):e504-e505.
[22]TOZZO P,CAENAZZO L,RODRIGUEZ D,et al.Delayed diagnosis of Wernicke encephalopathy with irreversible neural damage after subtotal gastrectomy for gastric cancer:A case of medical liability?[J].Int J Surg,2017,30:76-80.
[23]FRANK L L.Thiamin in Clinical Practice[J].JPEN J Parenter Enteral Nutr,2015,39(5):503-520.
[24]ASHRAF V V,PRIJESH J,PRAVEENKUMAR R,et al.Wernicke's encephalopathy due to hyperemesis gravidarum:Clinical and magnetic resonance imaging characteristics[J].J Postgrad Med,2016,62(4):260-263.
[25]ARMSTRONG GL,WASLEY A,SIMARD EP,et al.The prevalance of hepatitis C virus infection in the United States[J].Ann Intern Med,2006,144(10):705-714.
[66]周佩洋,高平.16例Wernicke脑病的临床及MR资料回顾性分析[J].湖北医药学院学报,2018,37(1):46-50;54.
[27]LIU D,KE Z,LUO J.Thiamine Deficiency and Neurodegeneration:the Interplay Among Oxidative Stress,Endoplasmic Reticulum Stress,and Autophagy[J].Mol Neurobiol,2017,54(7):1-9.
[28]XIN W,MEI X,FRANK J A,et al.Thiamine deficiency induces endoplasmic reticulum stress and oxidative stress in human neurons derived from induced pluripotent stem cells[J].Toxicol Appl Pharmacol,2017,320:26-31.
[29]HAZELL A S,FAIM S,WERTHEIMER G,et al.The impact of oxidative stress in thiamine deficiency:A multifactorial targeting issue[J].Neurochem Int,2013,62(5):796-802.
[30]DROR V,REHAVI M,BITON I E,et al.Rasagiline prevents neurodegeneration in thiamine deficient rats-a longitudinal MRI study[J].Brain Res,2014,1 557(15):43-54.
[31]AHMED M,AZIZI-NAMINI P,YAN A T,et al.Thiamin deficiency and heart failure:the current knowledge and gaps in literature[J].Heart Fail Rev,2015,20(1):1-11.
[32]DINICOLANTONIO J J,NIAZI A K,LAVIE C J,et al.Thiamine supplementation for the treatment of heart failure:a review of the literature[J].Congest Heart Fail,2013,19(4):214-222.
[33]MCCULLOCH B.High-Output Heart Failure Caused by Thyrotoxicosis and Beriberi[J].Crit Care NursClin North Am,2015,27(4):499-510.
[34]KOIKE H,WATANABE H,INUKAI A et al,Myopathy in thiamine deficiency:analysis of a case[J].J Neurol Sci,2006,249:175-179.
[35]HERNANDEZ-VAZQUEZ A J,GARCIA-SANCHEZ J A,MORENO-ARRIOLA E,et al,Thiamine deprivation produces a liver ATP deficit and metabolic and genomic effects in mice:findings are parallel to those of biotin deficiency and have implications for energy disorders[J].J Nutrigenet Nutrigenomics,2016,9:287-299.
[36]FATTOVICH G,STROFFOLINI T,ZAGNI I,et al.Hepatocellular carcinoma in cirrhosis:incidence and risk factors[J].Gastroenterology,2004,127(Suppl 1):S35-S50.
[37]徐安书,傅朝春.普通外科术后并Wernicke脑病诊断及治疗现状[J].世界最新医学信息文摘,2017,17(50):52-53.
[38]乔谷媛,刘玉,张小菜,等.妊娠剧吐致Wernicke脑病临床病例报道及分析[J].现代妇产科进展,2017,26(12):931-933.
[39]XIE B,SI Z Z,TANG W T,et al.Wernicke encephalopathy in a patient after liver transplantation:A case report[J].World J Gastroenterol,2017,23(47):8 432-8 436.
[40]陈宏,吴学勇,杨茹怡,等.胃肠道肿瘤术后并发韦尼克脑病的诊断与治疗[J].重庆医科大学学报,2016,41(3):261-265.
[41]楼大钧,朱麒钱,斯徐伟,等.妊娠剧吐合并妊娠期甲状腺毒症与Wernicke脑病1例报告[J].中华全科医学,2018,16(2):330-332.
[42]ONISHI H,ISHIDA M,TANAHASHI I,et al.Wernicke encephalopathy without delirium in patients with cancer[J].Palliat Support Care,2018,16(1):118-121.
[43]丰燕.维生素B1治疗妊娠剧吐并发Wernicke脑病的疗效[J].中国保健营养,2016,26(1):302.
[44]INFANTE MT,FANCELLU R,MURIALDO A,et al.Challenges in Diagnosis and Treatment of Wernicke Encephalopathy:Report of 2Cases[J].Nutr Clin Pract,2016,31(2):186-190.
[45]OUDMAN E,WIJNIA J W,DAM M V,et al.Preventing Wernicke Encephalopathy After Bariatric Surgery[J].Obes Surg,2018,28(7):2 060-2 068.
[46]DAY G S,CAMPO C M D.Wernicke encephalopathy:a medical emergency[J].Can Med Assn J,2014,186(8):E295.
[2]BRAZG J,RUEST A,LAW S,et al.A Therapeutic Fast for Lymphoma Resulting in Wernicke Encephalopathy[J].J Emerg Med,2015,49(4):471-474.
[3]DAY G S,CAMPO C M D.Wernicke encephalopathy:a medical emergency[J].Can Med Assn J,2014,186(8):E295.
[4]INFANTE M T,FANCELLU R,MURIALDO A,et al.Wernicke Encephalopathy:Challenges in Diagnosis and Treatment:Report of 2Cases[J].Nutr Clin Pract,2016,31(2):186.
[5]刘晓洋,李光雪,韩艳秋.Wernicke脑病的临床进展[J].中风与神经疾病,2016,33(5):479-480.
[6]GIUGALE L E,YOUNG O M,STREITMAN D C.Iatrogenic Wernicke encephalopathy in a patient with severe hyperemesis gravidarum[J].Obstet Gynecol,2015,125(5):1 150-1 152.
[7]ACAR A E,EKINCI S,AKKU爦P Z,et al.Wernicke encephalopathy due to thiamine deficiency after surgery on a child with duodenal stenosis[J].Pediatric Neurology,2014,51(6):840-842.
[8]RENTHAL W,MARINVALENCIA I,EVANS P A.Thiamine deficiency secondary to anorexia nervosa:an uncommon cause of peripheral neuropathy and Wernicke encephalopathy in adolescence[J].Pediatric Neurology,2014,51(1):100-103.
[9]SAAB R O,EL KHOURY M I,JABBOUR R A.Wernicke encephalopathy after Roux-en-Y gastric bypass and hyperemesis gravidarum[J].Surg Obes Relat Dis,2013,9(6):e105-e107.
[10]ZHANG S Q,GUAN Y T.Acute bilateral deafness as the first symptom of Wernicke encephalopathy[J].Am J Neuroradiol,2012,33(3):E44.
[11]JETHAVA A,DASANU C A.Acute Wernicke encephalopathy and sensorineural hearing loss compli-cating bariatric surgery[J].Conn Med,2012,76(10):603-605.
[12]KOTHA V K,DE SOUZA A.Wernicke's encephalopathy followinghyperemesis gravidarum a report of three cases[J].Neuroradiol J,2013,26(1):35-40.
[13]FALCO A D,SIMONE M D,SPITALERI D,et al.Non-alcoholic Wernicke-Korsakoff syndrome heralding non-Hodgkin lymphoma progression[J].Neurol Sci,2018,39:13.
[14]KOTHA V K,DE SOUZA A.Wernicke's encephalopathy followinghyperemesis gravidarum a report of three cases[J].Neuroradiol J,2013,26(1):35-40.
[15]JAN K.Wernicke encephalopathy:(MRI)picture worth a thousand words[J].Oxf Med Case Reports,2018,2018(5):omy013.
[16]TOTH A,ARADI G,VARALLYAY G.Wernicke's encephalopathy induced by the use of diet pills and unbalanced diet[J].Orv Hetil,2014,155(12):469-474.
[17]刘晓团,于博.结肠癌、肠梗阻术后并发Wernicke脑病原因分析[J].临床误诊误治,2014,27(8):71-72.
[18]KAMASAK T,KUL S,TUSAT M,et al.A Case of Wernicke Encephalopathy Developing After Ileal Bypass Surgery[J].Pediatr Emerg Care,2018:1.
[19]MILONE M,VELOTTI N,MUSELLA M.Wernicke Encephalopathy Following Laparoscopic Sleeve Gastrectomy-a Call to Evaluate Thiamine Deficiencies After Restrictive Bariatric Procedures[J].Obes Sur,2018,28(10):1-2.
[20]GAN Y C,JING J,QIU Z X,et al.Wernicke Encephalopathy in a Patient with Pulmonary and Abdominal Tuberculosis[J].Chin Med J,2017,130(22):2 757-2 758.
[21]ATHANASIOU A,SPARTALIS E,MORIS D,et al.Sleeve Gastrectomy and Wernicke Encephalopathy[J].Am J Ther,2016,24(4):e504-e505.
[22]TOZZO P,CAENAZZO L,RODRIGUEZ D,et al.Delayed diagnosis of Wernicke encephalopathy with irreversible neural damage after subtotal gastrectomy for gastric cancer:A case of medical liability?[J].Int J Surg,2017,30:76-80.
[23]FRANK L L.Thiamin in Clinical Practice[J].JPEN J Parenter Enteral Nutr,2015,39(5):503-520.
[24]ASHRAF V V,PRIJESH J,PRAVEENKUMAR R,et al.Wernicke's encephalopathy due to hyperemesis gravidarum:Clinical and magnetic resonance imaging characteristics[J].J Postgrad Med,2016,62(4):260-263.
[25]ARMSTRONG GL,WASLEY A,SIMARD EP,et al.The prevalance of hepatitis C virus infection in the United States[J].Ann Intern Med,2006,144(10):705-714.
[66]周佩洋,高平.16例Wernicke脑病的临床及MR资料回顾性分析[J].湖北医药学院学报,2018,37(1):46-50;54.
[27]LIU D,KE Z,LUO J.Thiamine Deficiency and Neurodegeneration:the Interplay Among Oxidative Stress,Endoplasmic Reticulum Stress,and Autophagy[J].Mol Neurobiol,2017,54(7):1-9.
[28]XIN W,MEI X,FRANK J A,et al.Thiamine deficiency induces endoplasmic reticulum stress and oxidative stress in human neurons derived from induced pluripotent stem cells[J].Toxicol Appl Pharmacol,2017,320:26-31.
[29]HAZELL A S,FAIM S,WERTHEIMER G,et al.The impact of oxidative stress in thiamine deficiency:A multifactorial targeting issue[J].Neurochem Int,2013,62(5):796-802.
[30]DROR V,REHAVI M,BITON I E,et al.Rasagiline prevents neurodegeneration in thiamine deficient rats-a longitudinal MRI study[J].Brain Res,2014,1 557(15):43-54.
[31]AHMED M,AZIZI-NAMINI P,YAN A T,et al.Thiamin deficiency and heart failure:the current knowledge and gaps in literature[J].Heart Fail Rev,2015,20(1):1-11.
[32]DINICOLANTONIO J J,NIAZI A K,LAVIE C J,et al.Thiamine supplementation for the treatment of heart failure:a review of the literature[J].Congest Heart Fail,2013,19(4):214-222.
[33]MCCULLOCH B.High-Output Heart Failure Caused by Thyrotoxicosis and Beriberi[J].Crit Care NursClin North Am,2015,27(4):499-510.
[34]KOIKE H,WATANABE H,INUKAI A et al,Myopathy in thiamine deficiency:analysis of a case[J].J Neurol Sci,2006,249:175-179.
[35]HERNANDEZ-VAZQUEZ A J,GARCIA-SANCHEZ J A,MORENO-ARRIOLA E,et al,Thiamine deprivation produces a liver ATP deficit and metabolic and genomic effects in mice:findings are parallel to those of biotin deficiency and have implications for energy disorders[J].J Nutrigenet Nutrigenomics,2016,9:287-299.
[36]FATTOVICH G,STROFFOLINI T,ZAGNI I,et al.Hepatocellular carcinoma in cirrhosis:incidence and risk factors[J].Gastroenterology,2004,127(Suppl 1):S35-S50.
[37]徐安书,傅朝春.普通外科术后并Wernicke脑病诊断及治疗现状[J].世界最新医学信息文摘,2017,17(50):52-53.
[38]乔谷媛,刘玉,张小菜,等.妊娠剧吐致Wernicke脑病临床病例报道及分析[J].现代妇产科进展,2017,26(12):931-933.
[39]XIE B,SI Z Z,TANG W T,et al.Wernicke encephalopathy in a patient after liver transplantation:A case report[J].World J Gastroenterol,2017,23(47):8 432-8 436.
[40]陈宏,吴学勇,杨茹怡,等.胃肠道肿瘤术后并发韦尼克脑病的诊断与治疗[J].重庆医科大学学报,2016,41(3):261-265.
[41]楼大钧,朱麒钱,斯徐伟,等.妊娠剧吐合并妊娠期甲状腺毒症与Wernicke脑病1例报告[J].中华全科医学,2018,16(2):330-332.
[42]ONISHI H,ISHIDA M,TANAHASHI I,et al.Wernicke encephalopathy without delirium in patients with cancer[J].Palliat Support Care,2018,16(1):118-121.
[43]丰燕.维生素B1治疗妊娠剧吐并发Wernicke脑病的疗效[J].中国保健营养,2016,26(1):302.
[44]INFANTE MT,FANCELLU R,MURIALDO A,et al.Challenges in Diagnosis and Treatment of Wernicke Encephalopathy:Report of 2Cases[J].Nutr Clin Pract,2016,31(2):186-190.
[45]OUDMAN E,WIJNIA J W,DAM M V,et al.Preventing Wernicke Encephalopathy After Bariatric Surgery[J].Obes Surg,2018,28(7):2 060-2 068.
[46]DAY G S,CAMPO C M D.Wernicke encephalopathy:a medical emergency[J].Can Med Assn J,2014,186(8):E295.