Bolton C F, Young G B, Zochodne D W
Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada.
Ann Neurol. 1993 Jan;33(1):94-100. doi: 10.1002/ana.410330115.
Encephalopathy and polyneuropathy occur in 70% of septic patients. The encephalopathy is diffuse, appears early, is often severe, but reverses quickly with successful treatment of the sepsis. The electroencephalogram is a sensitive indicator of the incidence and severity of the encephalopathy, but computed tomograms of the brain and cerebrospinal fluid findings are unremarkable. Critical-illness polyneuropathy develops later and in association with multiple-organ failure. Recovery is more gradual. Difficulty in weaning from the ventilator is an important early manifestation. Electromyography should be routinely performed to establish the diagnosis. The polyneuropathy is a primary axonal degeneration, predominantly of distal motor fibers. A persistent deficit may eventuate in severe cases. Whether muscle is affected as consistently as brain and peripheral nerve, and by the same process, has not been determined. Medications used in critical care units, notably sedatives and neuromuscular blocking agents, often confuse the clinical picture. The neurological pathophysiology is unknown but current evidence suggests that nervous system dysfunction arises through the same mechanisms as for systemic organs in the septic syndrome.
70%的脓毒症患者会出现脑病和多发性神经病。脑病呈弥漫性，出现较早，通常较为严重，但随着脓毒症的成功治疗会迅速逆转。脑电图是脑病发生率和严重程度的敏感指标，但脑部计算机断层扫描和脑脊液检查结果无明显异常。危重病性多发性神经病出现较晚，且与多器官功能衰竭相关。恢复较为缓慢。脱机困难是一个重要的早期表现。应常规进行肌电图检查以明确诊断。多发性神经病是一种原发性轴索变性，主要累及远端运动纤维。严重病例可能会出现持续性功能障碍。肌肉是否像脑和周围神经一样受到同等程度的影响以及是否由相同过程导致，目前尚未确定。重症监护病房中使用的药物，尤其是镇静剂和神经肌肉阻滞剂，常常会使临床表现变得复杂。神经病理生理学尚不清楚，但目前的证据表明，脓毒症综合征中神经系统功能障碍与全身器官功能障碍的发生机制相同。
