Intensive Care Unit, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Clinics (Sao Paulo). 2011;66(10):1825-31. doi: 10.1590/s1807-59322011001000024.
Sepsis is a major cause of mortality and morbidity in intensive care units. Organ dysfunction is triggered by inflammatory insults and tissue hypoperfusion. The brain plays a pivotal role in sepsis, acting as both a mediator of the immune response and a target for the pathologic process. The measurement of brain dysfunction is difficult because there are no specific biomarkers of neuronal injury, and bedside evaluation of cognitive performance is difficult in an intensive care unit. Although sepsis-associated encephalopathy was described decades ago, it has only recently been subjected to scientific scrutiny and is not yet completely understood. The pathophysiology of sepsis-associated encephalopathy involves direct cellular damage to the brain, mitochondrial and endothelial dysfunction and disturbances in neurotransmission. This review describes the most recent findings in the pathophysiology, diagnosis, and management of sepsis-associated encephalopathy and focuses on its many presentations.
脓毒症是重症监护病房患者死亡和发病的主要原因。器官功能障碍是由炎症损伤和组织低灌注引发的。大脑在脓毒症中起着关键作用，既是免疫反应的介质，也是病理过程的靶点。由于没有神经元损伤的特异性生物标志物，因此很难测量脑功能障碍，并且在重症监护病房中很难对认知功能进行床边评估。尽管脓毒症相关性脑病几十年前就已被描述，但直到最近才受到科学的关注，目前仍不完全了解。脓毒症相关性脑病的病理生理学涉及对大脑的直接细胞损伤、线粒体和内皮功能障碍以及神经递质传递紊乱。本文描述了脓毒症相关性脑病的病理生理学、诊断和治疗的最新发现，并重点介绍了其多种表现形式。
