Cerebral perfusion in sepsis-associated delirium.
Cerebral perfusion in sepsis-associated delirium.
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DOI：
10.1186/cc6891
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Steiner LA
中科院分区：
文献类型：
--
作者：
Pfister D;Siegemund M;Dell-Kuster S;Smielewski P;Rüegg S;Strebel SP;Marsch SC;Pargger H;Steiner LA
脓毒症相关谵妄的病理生理学尚未完全了解，并且脓毒症脑灌注的数据是相互矛盾的。我们检验了以下假设：患有或不患有脓毒症相关谵妄的脓毒症患者的脑灌注和选定的炎症和谵妄血清标记物存在差异。我们调查了 23 名患有脓毒症、严重脓毒症或感染性休克的成人患者，这些患者有颅外感染灶，但没有颅内病理史。患者在进入重症监护室后 48 小时内病情稳定后接受调查。使用重症监护病房的混乱评估方法诊断脓毒症相关的谵妄。使用经颅多普勒监测大脑中动脉的平均动脉压（MAP）、血流速度（FV），并使用近红外光谱仪监测脑组织氧合1小时。根据 MAP 和 FV 数据计算脑血管自动调节指数。在每次数据采集期间测量 C 反应蛋白 (CRP)、白介素 6 (IL-6)、S-100β 和皮质醇。对 16 名患者的数据进行了分析，其中 12 名患者患有脓毒症相关的谵妄。 MAP、脑血 FV 或组织氧合与脓毒症相关谵妄之间没有显着相关性或关联。然而，我们发现脓毒症相关谵妄与自动调节紊乱之间存在显着关联（P = 0.015）。 IL-6 在患有和不患有脓毒症相关谵妄的患者之间没有差异，但我们发现升高的 CRP (P = 0.008)、S-100β (P = 0.029) 和皮质醇 (P = 0.011) 与脓毒症相关谵妄之间存在显着关联。 CRP 升高与自身调节紊乱显着相关（Spearman rho = 0.62，P = 0.010）。在这一小群患者中，用经颅多普勒和近红外光谱仪评估的脑灌注在患有和不患有脓毒症相关谵妄的患者之间没有差异。然而，两组之间的自动调节状态不同。这可能是由于炎症阻碍脑血管内皮功能。需要进一步研究确定 S-100β 和皮质醇在脓毒症相关谵妄诊断中的作用。 ClinicalTrials.gov NCT00410111。
The pathophysiology of sepsis-associated delirium is not completely understood and the data on cerebral perfusion in sepsis are conflicting. We tested the hypothesis that cerebral perfusion and selected serum markers of inflammation and delirium differ in septic patients with and without sepsis-associated delirium. We investigated 23 adult patients with sepsis, severe sepsis, or septic shock with an extracranial focus of infection and no history of intracranial pathology. Patients were investigated after stabilisation within 48 hours after admission to the intensive care unit. Sepsis-associated delirium was diagnosed using the confusion assessment method for the intensive care unit. Mean arterial pressure (MAP), blood flow velocity (FV) in the middle cerebral artery using transcranial Doppler, and cerebral tissue oxygenation using near-infrared spectroscopy were monitored for 1 hour. An index of cerebrovascular autoregulation was calculated from MAP and FV data. C-reactive protein (CRP), interleukin-6 (IL-6), S-100β, and cortisol were measured during each data acquisition. Data from 16 patients, of whom 12 had sepsis-associated delirium, were analysed. There were no significant correlations or associations between MAP, cerebral blood FV, or tissue oxygenation and sepsis-associated delirium. However, we found a significant association between sepsis-associated delirium and disturbed autoregulation (P = 0.015). IL-6 did not differ between patients with and without sepsis-associated delirium, but we found a significant association between elevated CRP (P = 0.008), S-100β (P = 0.029), and cortisol (P = 0.011) and sepsis-associated delirium. Elevated CRP was significantly correlated with disturbed autoregulation (Spearman rho = 0.62, P = 0.010). In this small group of patients, cerebral perfusion assessed with transcranial Doppler and near-infrared spectroscopy did not differ between patients with and without sepsis-associated delirium. However, the state of autoregulation differed between the two groups. This may be due to inflammation impeding cerebrovascular endothelial function. Further investigations defining the role of S-100β and cortisol in the diagnosis of sepsis-associated delirium are warranted. ClinicalTrials.gov NCT00410111.
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影响因子：
8.3
作者：
Al-Rawi, PG;Smielewski, P;Kirkpatrick, PJ
通讯作者：
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8.8
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5
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