Hasselgren P O, Fischer J E
Intensive Care Med. 1986;12(1):13-6. doi: 10.1007/BF00315361.
There are widespread disturbances in hepatic and peripheral metabolism in sepsis. Prominent effects include elevated plasma concentrations of aromatic and sulfur-containing amino acids during sepsis, while BCAA are normal or reduced. These alterations probably in part reflect accelerated muscle protein breakdown and hepatic dysfunction. Concomitant with changes in plasma amino acids, altered brain levels of amino acids and neurotransmitters are observed. Increased brain concentrations of the serotoninergic and reduced levels of the catecholaminergic neurotransmitters, along with the occurrence of false neurotransmitters, may be important factors in the pathophysiology of septic encephalopathy. Although the main objective in the treatment of septic patients, of course, is to remove or drain the septic focus, recent studies have shown that administration of BCAA-enriched solutions may be beneficial in the improvement of metabolic derangements and septic encephalopathy. It should be emphasized that not a great deal of work has been done in this area, and the above results are preliminary and fragmentary. However, they do at least provide a working hypothesis for testing of another form of metabolic encephalopathy.
脓毒症时肝脏和外周代谢存在广泛紊乱。显著影响包括脓毒症期间血浆中芳香族和含硫氨基酸浓度升高，而支链氨基酸正常或降低。这些改变可能部分反映了肌肉蛋白分解加速和肝功能障碍。与血浆氨基酸变化同时，观察到脑内氨基酸和神经递质水平改变。血清素能神经递质在脑内浓度升高，儿茶酚胺能神经递质水平降低，以及假性神经递质的出现，可能是脓毒症脑病病理生理学中的重要因素。当然，治疗脓毒症患者的主要目标是清除或引流脓毒症病灶，但最近的研究表明，给予富含支链氨基酸的溶液可能有助于改善代谢紊乱和脓毒症脑病。应该强调的是，该领域尚未开展大量研究，上述结果是初步且不完整的。然而，它们至少为测试另一种形式的代谢性脑病提供了一个可行假设。
