Sepsis Associated Encephalopathy.
Sepsis Associated Encephalopathy.
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DOI：
10.1155/2014/762320
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发表时间：
2014
影响因子：
--
通讯作者：
Duggal AK
中科院分区：
文献类型：
--
作者：
Chaudhry N;Duggal AK
脓毒症相关性脑病（SAE）是脓毒症的常见但知之甚少的神经系统并发症。其特征是继发于体内其他部位感染的弥漫性脑功能障碍，而没有明显的中枢神经系统感染。SAE的病理生理学是复杂和多因素的，包括许多相互交织的机制，如血管损伤、内皮活化、血脑屏障破坏、脑信号传导改变、脑炎症和细胞凋亡。SAE的临床表现可能从轻度症状（如不适和注意力不集中）到深度昏迷。由于缺乏任何特定的检查或生物标志物以及危重患者常用镇静剂，因此难以对认知功能障碍进行评估。因此，SAE仍然是排除诊断，只有在通过适当的检查排除发热危重患者精神状态改变的其他原因后才能进行。尽管死亡率较高，但SAE的管理仅限于基础感染的治疗和谵妄和癫痫发作的对症治疗。重要的是要了解这种情况，因为SAE可能出现在脓毒症的早期阶段，甚至在脓毒症的诊断标准可以满足之前。这篇综述讨论了SAE患者的诊断方法沿着流行病学、病理生理学、临床表现和鉴别诊断。
Sepsis associated encephalopathy (SAE) is a common but poorly understood neurological complication of sepsis. It is characterized by diffuse brain dysfunction secondary to infection elsewhere in the body without overt CNS infection. The pathophysiology of SAE is complex and multifactorial including a number of intertwined mechanisms such as vascular damage, endothelial activation, breakdown of the blood brain barrier, altered brain signaling, brain inflammation, and apoptosis. Clinical presentation of SAE may range from mild symptoms such as malaise and concentration deficits to deep coma. The evaluation of cognitive dysfunction is made difficult by the absence of any specific investigations or biomarkers and the common use of sedation in critically ill patients. SAE thus remains diagnosis of exclusion which can only be made after ruling out other causes of altered mentation in a febrile, critically ill patient by appropriate investigations. In spite of high mortality rate, management of SAE is limited to treatment of the underlying infection and symptomatic treatment for delirium and seizures. It is important to be aware of this condition because SAE may present in early stages of sepsis, even before the diagnostic criteria for sepsis can be met. This review discusses the diagnostic approach to patients with SAE along with its epidemiology, pathophysiology, clinical presentation, and differential diagnosis.