Ebersoldt Marion, Sharshar Tarek, Annane Djillali
Université de Versailles Saint Quentin, Service de Réanimation Médicale, Hôpital Raymond Poincaré (AP-HP), 104 Boulevard Raymond Poincaré, 92380 Garches, France.
Intensive Care Med. 2007 Jun;33(6):941-50. doi: 10.1007/s00134-007-0622-2. Epub 2007 Apr 5.
Sepsis-associated delirium is a common and poorly understood neurological complication of sepsis. This review provides an update of the diagnostic criteria and treatment strategies and the current knowledge about the mechanisms involved in sepsis associated brain dysfunction.
Articles published between 1981 and 2006 were identified through a Medline search for "encephalopathy" and "sepsis" and by hand searching of articles cited in the identified publications. The immune response to sepsis results in multiorgan failure including brain dysfunction.
The potential mechanisms for sepsis-associated delirium include vascular damage, endothelial activation, breakdown of the blood-brain barrier, metabolic disorders, brain inflammation and apoptosis. On the other hand, there is evidence for distinct neuroprotective factors, such as anti-inflammatory mediators and glial cell activity.
The diagnosis of sepsis-associated delirium relies mainly on clinical and electrophysiological criteria, and its treatment is entirely based on general management of sepsis.
脓毒症相关性谵妄是脓毒症常见但了解较少的神经并发症。本综述对脓毒症相关性脑功能障碍的诊断标准、治疗策略及相关机制的现有知识进行了更新。
通过对1981年至2006年间发表的文章进行医学数据库检索，检索词为“脑病”和“脓毒症”，并手动检索已识别出版物中引用的文章。对脓毒症的免疫反应会导致包括脑功能障碍在内的多器官功能衰竭。
脓毒症相关性谵妄的潜在机制包括血管损伤、内皮激活、血脑屏障破坏、代谢紊乱、脑部炎症和细胞凋亡。另一方面，有证据表明存在不同的神经保护因子，如抗炎介质和神经胶质细胞活性。
脓毒症相关性谵妄的诊断主要依赖临床和电生理标准，其治疗完全基于脓毒症的一般管理。
