脓毒症相关性脑病：全面综述。
Septic-Associated Encephalopathy: a Comprehensive Review.
机构信息
GHU Paris Psychiatrie et Neuroscience, Neurointensive Care and Neuroanesthesia Department, 1, rue Cabanis, 75014, Paris, France.
Medical Intensive Care Unit, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France.
出版信息
Neurotherapeutics. 2020 Apr;17(2):392-403. doi: 10.1007/s13311-020-00862-1.
Abstract
Septic-associated encephalopathy (SAE) is a key manifestation of sepsis, ranging from delirium to coma and occurring in up to 70% of patients admitted to the ICU. SAE is associated with higher ICU and hospital mortality, and also with poorer long-term outcomes, including cognitive and functional outcomes. The pathophysiology of SAE is complex, and it may involve neurotransmitter dysfunction, inflammatory and ischemic lesions to the brain, microglial activation, and blood-brain barrier dysfunction. Delirium (which is included in the SAE spectrum) is mostly diagnosed with validated scales in the ICU population. There is no established treatment for SAE; benzodiazepines should generally be avoided in this setting. Nonpharmacological prevention and management is key for treating SAE; it includes avoiding oversedation (mainly with benzodiazepines), early mobilization, and sleep promotion.
摘要
脓毒症相关性脑病（SAE）是脓毒症的一个重要表现，其范围从意识混乱到昏迷，在入住 ICU 的患者中发生率高达 70%。SAE 与 ICU 和医院死亡率升高相关，也与较差的长期预后相关，包括认知和功能结局。SAE 的病理生理学很复杂，可能涉及神经递质功能障碍、脑的炎症和缺血性病变、小胶质细胞激活和血脑屏障功能障碍。意识混乱（包含在 SAE 谱中）主要通过 ICU 人群中的经验证量表来诊断。SAE 尚无既定的治疗方法；在这种情况下，一般应避免使用苯二氮䓬类药物。非药物预防和管理是治疗 SAE 的关键；包括避免过度镇静（主要是使用苯二氮䓬类药物）、早期活动和促进睡眠。
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