2022 年第 10 期 第 17 卷

儿童消化道疾病术后Wernicke′s脑病3例临床特征分析

Clinical characteristics analysis of 3 cases of Wernicke′s encephalopathy in children with gastrointestinaldiseases after surgery  

作者：张建昭1叶茂2郑萍1孙静1李冠男1李龙2李旭2陈倩1  

英文作者：Zhang Jianzhao1 Ye Mao2 Zheng Ping1 Sun Jing1 Li Guannan1 Li Long2 Li Xu2 Chen Qian1

单位：1首都儿科研究所附属儿童医院神经内科，北京100020；2首都儿科研究所附属儿童医院普通（新生儿）外科，北京100020

英文单位：1Department of Neurology Children′s Hospital Capital Institute of Pediatrics Beijing 100020 China; 2Department of General(Neonatal) Surgery Children′s Hospital Capital Institute of Pediatrics Beijing 100020 China

关键词：Wernicke′s脑病；消化道疾病手术；临床特征

英文关键词：Wernicke′sencephalopathy;Surgeryforgastrointestinaldiseases;Clinicalcharacteristics

• 摘要：

• Wernicke′s 脑病（WE）是一种维生素B1缺乏所致急性脑病综合征，消化系统疾病及胃肠道手术为其常见诱因。本研究共收集到与消化道手术相关的WE患儿3例，回顾性分析患儿的临床表现、辅助检查和预后。旨在总结消化道疾病术后发生的WE的临床特点，提高对该病的认识，从而引导临床医师加强消化道疾病围术期患儿管理。3例患儿的临床表现包括言语障碍3例、共济失调3例、精神行为异常3例、眼震3例、视物模糊2例、不自主运动2例。头颅磁共振成像异常部位包括基底节、丘脑、脑干、中脑导水管和额叶病变。3例患儿长时间静脉营养，摄入维生素B1较少，为0.1～0.3 mg/d。经过给予维生素B1等积极治疗，在随访中，均获得了临床痊愈和头颅磁共振成像表现的恢复，恢复时间为1～2个月。我们认为对于消化道疾病围术期长期禁食水的患儿应警惕WE的发生，需注意每天维生素B1的摄入量。

• Wernicke′s encephalopathy(WE) is an acute encephalopathy syndrome caused by vitamin B1 deficiency. Digestive diseases and gastrointestinal surgery are common inducements. A total of 3 cases of WE related to gastrointestinal surgery were collected in this study. The clinical manifestations, auxiliary examinations and prognosis of the children were analyzed retrospectively. The purpose is to summarize the clinical characteristics of WE after gastrointestinal surgery, improve the understanding of the disease, and guide clinicians to strengthen the management of perioperative children with gastrointestinal diseases. The clinical manifestations of 3 children included speech disorders in 3 cases, ataxia in 3 cases, psychobehavioral abnormalities in 3 cases, nystagmus in 3 cases, blurred vision in 2 cases, and involuntary movement in 2 cases. Abnormal brain magnetic resonance imaging sites included basal ganglia, thalamus, brain stem, midbrain aqueduct and frontal lobe. Three children received intravenous nutrition for a long time and lacked vitamin B1 intake(only 0.1-0.3 mg/d). After active treatment such as vitamin B1, the recovery of clinical syndrome and magnetic resonance imaging were achieved during the follow-up, and the recovery time was 1-2 months. We believed that WE should be alert to the occurrence for children with gastrointestinal diseases who have been fasting for a long time during perioperative period, and increased daily intake of vitamin B1.