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新冠后神经系统综合征:对后遗症治疗的启示。

Post-COVID 19 neurological syndrome: Implications for sequelae's treatment.

机构信息

Medical and Surgical Research Center, School of Medicine, University of Cartagena, Cartagena, Colombia.

Medical and Surgical Research Center, School of Medicine, University of Cartagena, Cartagena, Colombia; Colombian Clinical Research Group in Neurocritical Care, School of Medicine, University of Cartagena, Cartagena, Colombia; Latin American Council of Neurocritical Care, Cartagena, Colombia.

出版信息

J Clin Neurosci. 2021 Jun;88:219-225. doi: 10.1016/j.jocn.2021.04.001. Epub 2021 Apr 8.

Abstract

UNLABELLED

Study design Literature review.

OBJECTIVES

Describe the implications of post-COVID syndrome due to neurological sequelae including treatment and the differences that may exist between this group of patients and those who present these events not associated with COVID-19.

METHODS

A non-systematic review of the literature was carried out in PubMed and Science Direct databases, using the keywords "Post-acute COVID-19 syndrome"; "Neurological complications"; "Neurologic Manifestations" "COVID-19″ and "Rehabilitation", as well as synonyms, which were combined with the operators "AND" and "OR".

RESULTS

The COVID-19 viral caustive agent, SARS-CoV-2, has a high affinity for human angiotensin-converting enzyme 2 receptor on type II pneumocytes. This receptor is also expressed in neurons and glial cells. Based on the foregoing and other not so clear mechanisms, it is stated that SARS-CoV-2 has tropism for the nervous system, being evident through the neurological manifestations observed in patients with mild, moderate and severe phenotype of the disease such as anosmia, ageusia, headache, cerebrovascular accidents, Guillain-Barré syndrome, seizures, and encephalopathy. This can generate severe sequelae and even fatal outcomes in those affected.

CONCLUSIONS

Neurological complications caused by COVID-19 are frequent and represent a risk that compromises the functional capacity and the life of patients. The suspicion of these conditions, the strict control of metabolic alterations and cardiovascular risk factors, the effective and safe treatment of these entities, are a current challenge throughout the pandemic. The rehabilitation process in these patients is a challenge. This is due to the limitations generated by multi-organ damage, as well as risk of brain death.

摘要

目的

描述与 COVID-19 无关的神经系统后遗症引起的新冠后综合征的影响,包括治疗方法以及此类患者与出现这些非 COVID-19 相关事件的患者之间可能存在的差异。

方法

在 PubMed 和 Science Direct 数据库中进行了非系统性文献回顾,使用的关键词是“Post-acute COVID-19 syndrome”、“Neurological complications”、“Neurologic Manifestations”、“COVID-19”和“Rehabilitation”,以及同义词,并用“AND”和“OR”运算符将这些关键词结合起来。

结果

新冠病毒 SARS-CoV-2 的致病因子对 II 型肺泡细胞表面的人血管紧张素转换酶 2 受体具有高亲和力。该受体也在神经元和神经胶质细胞中表达。基于上述机制以及其他不太明确的机制,有人指出,SARS-CoV-2 对神经系统具有亲嗜性,这在疾病轻症、中症和重症患者中观察到的神经系统表现中显而易见,如嗅觉丧失、味觉丧失、头痛、脑血管意外、格林-巴利综合征、癫痫发作和脑病。这会给受影响的人带来严重的后遗症,甚至是致命的后果。

结论

由 COVID-19 引起的神经系统并发症很常见,这代表了一种风险,会损害患者的功能能力和生命。对这些情况的怀疑、对代谢改变和心血管危险因素的严格控制、对这些疾病实体的有效和安全治疗,是整个大流行期间的一个当前挑战。对这些患者的康复过程是一个挑战。这是由于多器官损伤以及脑死亡的风险所导致的。

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