Chen R, Young G B
Human Motor Control Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD 20892, USA.
Baillieres Clin Neurol. 1996 Oct;5(3):577-98.
Metabolic encephalopathies are common among patients in the critical care unit. Septic, hypoxic-ischaemic, hepatic and uraemic encephalopathies are most frequently seen. They produce global neurological dysfunctions ranging from lethargy or mild confusion to coma. Metabolic encephalopathies must be distinguished from other conditions such as structural brain lesions, infections of the central nervous system or drug reactions. Neurological manifestations are often present in the early stages of systemic illness and may be the first symptom. The severity of encephalopathy generally correlates with that of the systemic illness. Appropriate investigations often include drug and metabolic screens, cultures of blood and cerebrospinal fluids and neuro-imaging studies. Electroencephalogram is useful to grade the severity of encephalopathy. With some exceptions such as hypoxic-ischaemic encephalopathy, most metabolic encephalopathies are reversible unless secondary complications such as brain herniation occurred. Treatment is generally that of the underlying systemic illness and supportive measures.
代谢性脑病在重症监护病房的患者中很常见。脓毒症性、缺氧缺血性、肝性和尿毒症性脑病最为常见。它们会导致全身性神经功能障碍，从嗜睡或轻度意识模糊到昏迷不等。代谢性脑病必须与其他疾病相鉴别，如脑结构性病变、中枢神经系统感染或药物反应。神经症状通常出现在全身性疾病的早期阶段，可能是首发症状。脑病的严重程度通常与全身性疾病的严重程度相关。适当的检查通常包括药物和代谢筛查、血液和脑脊液培养以及神经影像学检查。脑电图有助于评估脑病的严重程度。除了缺氧缺血性脑病等一些例外情况，大多数代谢性脑病是可逆的，除非发生脑疝等继发性并发症。治疗通常是针对潜在的全身性疾病并采取支持措施。
