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中华卫生应急电子杂志 ›› 2023, Vol. 09 ›› Issue (03) : 171 -175. doi: 10.3877/cma.j.issn.2095-9133.2023.03.009

综述

脓毒症脑病的诊治及研究进展
陈籽荣, 孙同文()   
  1. 450052 河南郑州,郑州大学第一附属医院重症医学科、急诊医学科、河南省重症医学工程技术研究中心、河南省重症医学重点实验室、郑州市脓毒症重点实验室、河南省脓毒症诊疗中心
  • 收稿日期:2023-06-03 出版日期:2023-06-18
  • 通信作者: 孙同文
  • 基金资助:
    国家自然科学基金联合基金项目(U2004110); 国家自然科学基金面上项目(82172129); 中央引导地方科技发展基金(Z20221343037); 河南省医学科技攻关计划省部共建重大项目(SBGJ202101015)

Progress in the diagnosis and treatment of sepsis encephalopathy

Zirong Chen, Tongwen Sun()   

  • Received:2023-06-03 Published:2023-06-18
  • Corresponding author: Tongwen Sun
引用本文:

陈籽荣, 孙同文. 脓毒症脑病的诊治及研究进展[J]. 中华卫生应急电子杂志, 2023, 09(03): 171-175.

Zirong Chen, Tongwen Sun. Progress in the diagnosis and treatment of sepsis encephalopathy[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2023, 09(03): 171-175.

脓毒症是机体对感染反应失调所导致的危及生命的器官功能障碍,是重症监护病房(intensive care unit,ICU)患者死亡的主要原因[1,2]。脓毒症脑病(sepsis-associated encephalopathy,SAE)是指脓毒症累及患者中枢神经系统后引起的弥漫性脑功能障碍,可表现为谵妄、昏迷等不同程度的意识障碍[3]。既往研究显示[4,5],由于患者脓毒症的严重程度、基本情况、SAE的诊断标准不一,脓毒症患者继发SAE的发生率为8%~70%。患者可出现远期认知及功能障碍(记忆力下降、注意力不集中和语言表达能力下降等)及心理障碍(焦虑、抑郁和创伤后应激障碍等),预后不佳[4,5]。研究表明[3,6,7,8],SAE的病理生理学发病机制错综复杂,可能涉及神经递质功能障碍、脑组织炎症反应、脑组织缺血、小胶质细胞激活及血脑屏障功能障碍等多个方面。因SAE缺乏特异性电生理及影像学表现,临床主要为排除性诊断。其治疗主要是基于脓毒症的管理、脏器功能的支持、潜在危险因素的纠正、对癫痫、谵妄等意识障碍的对症处理,目前尚无规范化的统一治疗方案。因此,笔者结合SAE的最新研究进展,对SAE的病理生理机制、诊断及治疗进行综述。

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