Anaesthesia and Intensive Care, IRCCS for Oncology, San Martino Policlinico Hospital, Genova, Italy.
Department of Surgical Sciences and Integrated Diagnostic, University of Genova, Genova, Italy.
Curr Neurol Neurosci Rep. 2018 Oct 2;18(12):82. doi: 10.1007/s11910-018-0895-6.
To discuss the diagnostic approach to patients with septic encephalopathy as well as the need for specific neuro-monitoring and the perspectives on future therapeutic approaches in this setting.
Most of data-concern experimental studies evaluating the pathophysiology of septic encephalopathy. A combination of neurodegenerative pathways with neurovascular injury is the cornerstone for the development of such complication and the long-term neurological sequelae among survivors. Septic encephalopathy is a common complication in septic patients. Clinical presentation may range from mild confusion and disorientation to convulsions and deep coma. The diagnosis of septic encephalopathy is made difficult by the lack of any specific clinical and non-clinical feature, in particular among sedated patients in whom neurological examination is unreliable. In spite of the high mortality rate associated with this condition, there is no prophylactic or targeted therapy to reduce or minimize brain damage in septic patients and clinical management is limited to the treatment of the underlying infection.
讨论脓毒性脑病患者的诊断方法,以及在此情况下进行特定神经监测的必要性和未来治疗方法的前景。
大部分数据均为评估脓毒性脑病病理生理学的实验研究。神经退行性通路与神经血管损伤的结合是该并发症发生和幸存者长期神经后遗症的基础。脓毒性脑病是脓毒症患者的常见并发症。临床表现可从轻度意识混乱和定向障碍到抽搐和深度昏迷不等。由于缺乏任何特定的临床和非临床特征,特别是在镇静患者中,神经检查不可靠,使得脓毒性脑病的诊断变得困难。尽管这种情况的死亡率很高,但目前尚无预防或靶向治疗方法可减少或最小化脓毒症患者的脑损伤,临床治疗仅限于治疗基础感染。