Maekawa T, Fujii Y, Sadamitsu D, Yokota K, Soejima Y, Ishikawa T, Miyauchi Y, Takeshita H
Division of Critical Care Medicine, Yamaguchi University Hospital, Japan.
Am J Emerg Med. 1991 Mar;9(2):139-43. doi: 10.1016/0735-6757(91)90175-j.
Cerebral circulation and metabolism in septic encephalopathy have not been well documented. The authors measured cerebral blood flow (CBF) and metabolic rate for oxygen (CMRO2) in six patients with septic encephalopathy associated with multiple organ failure (three to five organs). They found that CBF and CMRO2 were significantly lower than awake control values of 46 +/- 2 to 28 +/- 3 mL/100g/min (mean +/- SEM) and 3.1 +/- 0.2 to 1.2 +/- 0.2 mL/100g/min, respectively. Cerebral vascular resistance (CVR) and cerebral circulatory index (CCI:CBF/CMRO2) were significantly higher than the control values of 2.0 +/- 0.1 to 3.0 +/- 0.4 mm Hg/mL/100g/min and 15.1 +/- 0.8 to 24.2 +/- 3.3, respectively. At the time of cerebral circulatory and metabolic measurements, their consciousness varied between 4 and 10 as evaluated by the Glasgow coma scale. The electroencephalogram showed diffuse slow wave activity and the latency of the auditory brain stem evoked response was prolonged in four of six patients. Computed brain tomography showed either no abnormality or mild atrophy. It is concluded that CBF and CMRO2 are disproportionally decreased during septic encephalopathy in association with dysfunction of the CNS and decreased electrical activity.
脓毒症性脑病的脑循环和代谢情况尚未得到充分记录。作者测量了6例伴有多器官功能衰竭（3至5个器官）的脓毒症性脑病患者的脑血流量（CBF）和脑氧代谢率（CMRO2）。他们发现，CBF和CMRO2分别显著低于清醒对照组的值，清醒对照组的CBF为46±2至28±3 mL/100g/分钟（平均值±标准误），CMRO2为3.1±0.2至1.2±0.2 mL/100g/分钟。脑血管阻力（CVR）和脑循环指数（CCI：CBF/CMRO2）分别显著高于对照组的值，对照组的CVR为2.0±0.1至3.0±0.4 mmHg/mL/100g/分钟，CCI为15.1±0.8至24.2±3.3。在进行脑循环和代谢测量时，根据格拉斯哥昏迷量表评估，他们的意识水平在4至10分之间。脑电图显示弥漫性慢波活动，6例患者中有4例听觉脑干诱发电位潜伏期延长。计算机断层扫描显示无异常或轻度萎缩。得出的结论是，在脓毒症性脑病期间，与中枢神经系统功能障碍和电活动降低相关，CBF和CMRO2不成比例地降低。
