Schiffman Susan S
Department of Psychiatry, 54212 Woodhall Building, Duke University Medical Center, Durham, NC 27710-3259, USA.
Proc Nutr Soc. 2007 Aug;66(3):331-45. doi: 10.1017/S0029665107005599.
Impairments of sensory perception that occur during a period of critical care can seriously impact on health and nutritional status, activities of daily living, independence, quality of life and the possibility of recovery. It is emphasized from the outset that sensory losses in critically-ill patients may or may not be related to their current medical condition. The present paper provides an overview of all five senses (vision, hearing, taste, smell and touch) and describes the factors that contribute to sensory losses in critically-ill patients, including medications, medical conditions and treatments and the process of aging itself. Cancer and stroke are two critical illnesses in which profound sensory decrements often occur. Many sensory complaints in patients with cancer are related to alteration in sensory signals caused by damage to the sensory receptors. However, some complaints, such as taste aversions in patients with cancer, are not related to altered sensory physiology per se but to learned aversions that arise during the noxious effects of radiotherapy and chemotherapy. The paper also reviews a study in which the sensory performance (of all five senses) was compared in three groups of elderly subjects: (1) patients who had undergone coronary artery bypass surgery; (2) patients with cardiovascular conditions but with no history of surgery; (3) healthy non-medicated age-matched controls. Performance of patients who had undergone coronary artery bypass surgery was worse than that for the other two groups, with taste and smell losses greater than for the other senses. The study demonstrates that critical illness (e.g. coronary artery bypass surgery) can exacerbate sensory losses in an older cohort.
重症监护期间发生的感觉感知障碍会严重影响健康和营养状况、日常生活活动能力、独立性、生活质量以及康复的可能性。从一开始就强调，重症患者的感觉丧失可能与他们当前的病情有关，也可能无关。本文概述了所有五种感官（视觉、听觉、味觉、嗅觉和触觉），并描述了导致重症患者感觉丧失的因素，包括药物、疾病状况和治疗方法以及衰老过程本身。癌症和中风是两种经常会出现严重感觉减退的重症疾病。癌症患者的许多感觉不适与感觉感受器受损导致的感觉信号改变有关。然而，一些不适，如癌症患者的味觉厌恶，本身与感觉生理改变无关，而是与放疗和化疗的有害作用期间产生的习得性厌恶有关。本文还回顾了一项研究，该研究比较了三组老年受试者（所有五种感官的）感觉表现：（1）接受冠状动脉搭桥手术的患者；（2）有心血管疾病但无手术史的患者；（3）健康的未用药年龄匹配对照组。接受冠状动脉搭桥手术的患者的表现比其他两组差，味觉和嗅觉丧失比其他感官更严重。该研究表明，重症疾病（如冠状动脉搭桥手术）会加剧老年人群的感觉丧失。
