Schmutzhard E, Pfausler B
Neurocritical Care Unit, Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
Neurocritical Care Unit, Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
Handb Clin Neurol. 2017;141:675-683. doi: 10.1016/B978-0-444-63599-0.00036-3.
Over the past decades, the incidence of sepsis and resultant neurologic sequelae has increased, both in industrialized and low- or middle-income countries, by approximately 5% per year. Up to 300 patients per 100 000 population per year are reported to suffer from sepsis, severe sepsis, and septic shock. Mortality is up to 30%, depending on the precision of diagnostic criteria. The increasing incidence of sepsis is partially explained by demographic changes in society, with aging, increasing numbers of immunocompromised patients, dissemination of multiresistant pathogens, and greater availability of supportive medical care in both industrialized and middle-income countries. This results in more septic patients being admitted to intensive care units. Septic encephalopathy is a manifestation especially of severe sepsis and septic shock where the neurologist plays a crucial role in diagnosis and management. It is well known that timely treatment of sepsis improves outcome and that septic encephalopathy may precede other signs and symptoms. Particularly in the elderly and immunocompromised patient, the brain may be the first organ to show signs of failure. The neurologist diagnosing early septic encephalopathy may therefore contribute to the optimal management of septic patients. The brain is not only an organ failing in sepsis (a "sepsis victim" - as with other organs), but it also overwhelmingly influences all inflammatory processes on a variety of pathophysiologic levels, thus contributing to the initiation and propagation of septic processes. Therefore, the best possible pathophysiologic understanding of septic encephalopathy is essential for its management, and the earliest possible therapy is crucial to prevent the evolution of septic encephalopathy, brain failure, and poor prognosis.
在过去几十年中，无论是在工业化国家还是低收入或中等收入国家，脓毒症及其所致神经后遗症的发病率均以每年约5%的速度上升。据报告，每年每10万人口中多达300人患有脓毒症、严重脓毒症和脓毒性休克。根据诊断标准的精确程度，死亡率高达30%。脓毒症发病率上升的部分原因是社会人口结构的变化，包括老龄化、免疫功能低下患者数量增加、多重耐药病原体的传播，以及工业化国家和中等收入国家支持性医疗服务的可及性提高。这导致更多脓毒症患者被收入重症监护病房。脓毒性脑病是严重脓毒症和脓毒性休克的一种表现，神经科医生在其诊断和管理中起着关键作用。众所周知，及时治疗脓毒症可改善预后，且脓毒性脑病可能先于其他体征和症状出现。特别是在老年人和免疫功能低下的患者中，大脑可能是首个出现功能衰竭迹象的器官。因此，神经科医生早期诊断脓毒性脑病可能有助于脓毒症患者的最佳管理。大脑不仅是脓毒症中功能衰竭的器官（如同其他器官一样是“脓毒症受害者”），而且在多种病理生理层面上对所有炎症过程产生压倒性影响，从而促成脓毒症过程的起始和传播。因此，对脓毒性脑病进行尽可能最佳的病理生理理解对于其管理至关重要，尽早进行治疗对于预防脓毒性脑病的进展、脑功能衰竭和不良预后至关重要。
