Hotchkiss R S, Rust R S, Song S K, Ackerman J J
Department of Anesthesiology, Washington University, St. Louis, Missouri.
Circ Shock. 1993 Aug;40(4):303-10.
Neurological abnormalities including agitation, confusion, disorientation, lethargy, and obtundation are early characteristic findings in patients with sepsis. The etiology of the changes in mental status that occur during severe infection is unknown. We investigated the effects of sepsis on intermediary metabolism and bioenergetics in the brain during normoxia and moderate hypoxia (8% inspired O2 concentration) in rats 36-42 hr following cecal ligation and perforation. The rats were anesthetized with halothane, and brains frozen using the funnel-freezing technique. Perchloric acid extracts of brains were analyzed with fluorometric enzymatic methods and 31P nuclear magnetic resonance spectroscopy. There was no impairment in bioenergetics or intermediary metabolism in septic brain, and sepsis did not compromise the ability of the brain to maintain high-energy phosphates during hypoxia. Hypoxia did cause the brain lactate-to-pyruvate ratio to increase equivalently in both septic and control rats from approximately 9:1 to 20:1 (P < 0.001). We conclude that the neurologic changes which are characteristic of sepsis are unlikely to be due to alterations in cellular energy stores or intermediately metabolism. In addition, there is no evidence that sepsis results in brain cellular hypoxia.
神经系统异常，包括烦躁、意识模糊、定向障碍、嗜睡和迟钝，是脓毒症患者早期的特征性表现。严重感染期间发生的精神状态变化的病因尚不清楚。我们在大鼠盲肠结扎和穿孔后36 - 42小时，研究了脓毒症在常氧和中度缺氧（吸入氧气浓度8%）情况下对大脑中间代谢和生物能量学的影响。大鼠用氟烷麻醉，采用漏斗冷冻技术冷冻大脑。用荧光酶法和31P核磁共振波谱法分析脑的高氯酸提取物。脓毒症脑的生物能量学或中间代谢没有受损，脓毒症也没有损害大脑在缺氧期间维持高能磷酸盐的能力。缺氧确实导致脓毒症大鼠和对照大鼠的脑乳酸与丙酮酸比值同等增加，从约9:1增至20:1（P < 0.001）。我们得出结论，脓毒症特征性的神经学变化不太可能是由于细胞能量储备或中间代谢的改变所致。此外，没有证据表明脓毒症会导致脑细胞缺氧。
