Clinical neurophysiological assessment of sepsis-associated brain dysfunction: a systematic review.
Clinical neurophysiological assessment of sepsis-associated brain dysfunction: a systematic review.
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DOI：
10.1186/s13054-014-0674-y
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发表时间：
2014-12-08
期刊：
影响因子：
--
通讯作者：
Taccone FS
中科院分区：
文献类型：
--
作者：
Hosokawa K;Gaspard N;Su F;Oddo M;Vincent JL;Taccone FS
几项研究报告了脓毒症期间存在脑电图（EEG）异常或诱发电位（EP）改变。然而，这些测试在脓毒症相关脑病的诊断和预后评估中的作用仍不清楚。我们对评估脓毒症相关脑病成人（≥18 岁）患者脑电图和/或 EP 的研究进行了系统检索。提取了以下结果：a) EEG/EP 异常的发生率； b) 通过 EEG/EP 诊断脓毒症相关谵妄或脑病； c) 结果。在 1976 篇引用中，有 17 篇文章符合纳入标准。脓毒症期间脑电图异常的发生率在背景异常时为 12% 至 100%，在三相波存在时为 6% 至 12%。两项研究发现，癫痫样放电和电图癫痫发作在患有脓毒症的危重患者中比没有脓毒症的患者更常见。在一项研究中，脑电图背景异常与脑病的存在和严重程度有关。背景减慢或抑制以及三相波的存在也与较高的死亡率相关。一些研究表明，定量脑电图分析和电生理可以显示脓毒症患者与对照组相比存在显着差异，但未评估它们与脑病和结果的关联。大多数脓毒症患者存在脑电图和电生理异常。有一些证据支持脑电图用于脓毒症相关脑病的检测和预测，但需要进一步的临床研究来证实这一建议。
Several studies have reported the presence of electroencephalography (EEG) abnormalities or altered evoked potentials (EPs) during sepsis. However, the role of these tests in the diagnosis and prognostic assessment of sepsis-associated encephalopathy remains unclear. We performed a systematic search for studies evaluating EEG and/or EPs in adult (≥18 years) patients with sepsis-associated encephalopathy. The following outcomes were extracted: a) incidence of EEG/EP abnormalities; b) diagnosis of sepsis-associated delirium or encephalopathy with EEG/EP; c) outcome. Among 1976 citations, 17 articles met the inclusion criteria. The incidence of EEG abnormalities during sepsis ranged from 12% to 100% for background abnormality and 6% to 12% for presence of triphasic waves. Two studies found that epileptiform discharges and electrographic seizures were more common in critically ill patients with than without sepsis. In one study, EEG background abnormalities were related to the presence and the severity of encephalopathy. Background slowing or suppression and the presence of triphasic waves were also associated with higher mortality. A few studies demonstrated that quantitative EEG analysis and EP could show significant differences in patients with sepsis compared to controls but their association with encephalopathy and outcome was not evaluated. Abnormalities in EEG and EPs are present in the majority of septic patients. There is some evidence to support EEG use in the detection and prognostication of sepsis-associated encephalopathy, but further clinical investigation is needed to confirm this suggestion.
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