Stevens Robert D, Pronovost Peter J
Department of Anesthesiology-Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Semin Neurol. 2006 Sep;26(4):440-51. doi: 10.1055/s-2006-948325.
Beyond the cerebral impact of cardiac arrest, recent research indicates a high prevalence of neurological disturbances such as delirium and coma among patients admitted to the intensive care unit (ICU). These disturbances, grouped here under the term "encephalopathy," may be overlooked while attention is devoted to reversing life-threatening imbalances in cardiac and pulmonary function. Nevertheless, there is ample evidence that encephalopathy is an independent predictor of mortality. Factors associated with encephalopathy include primary cerebral disorders such as stroke, trauma, and meningitis, or systemic derangements including sepsis, organ failure, and exposure to pharmacological agents and toxins. Although encephalopathy may resolve with treatment of the underlying disorder, there is mounting evidence that cerebral dysfunction persists beyond the acute phase of critical illness. ICU survivors often suffer chronic impairments in cognitive ability, suggesting occult brain injury. The pathogenesis and natural history of encephalopathy, still poorly understood, need further clarification to spur the development of effective preventive and therapeutic interventions.
除心脏骤停对大脑的影响外，近期研究表明，在入住重症监护病房（ICU）的患者中，谵妄和昏迷等神经功能障碍的发生率很高。这些障碍在这里统称为“脑病”，在致力于纠正危及生命的心肺功能失衡时，可能会被忽视。然而，有充分证据表明，脑病是死亡率的独立预测因素。与脑病相关的因素包括原发性脑部疾病，如中风、创伤和脑膜炎，或全身性紊乱，包括败血症、器官衰竭以及接触药物和毒素。尽管脑病可能随着潜在疾病的治疗而得到缓解，但越来越多的证据表明，脑功能障碍在危重病急性期过后仍会持续存在。ICU幸存者常常存在认知能力的慢性损害，提示存在隐匿性脑损伤。脑病的发病机制和自然病程仍知之甚少，需要进一步阐明，以推动有效预防和治疗干预措施的发展。
