Cerebral circulation and metabolism associated with other organ failure in septic patients

脓毒症患者的脑循环和代谢与其他器官衰竭相关

• 批准号: 03670728
• 负责人: TATEISHI Akio
• 金额: $ 1.28万
• 依托单位: Yamaguchi University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for General Scientific Research (C)
• 财政年份: 1991
• 资助国家: 日本
• 起止时间: 1991 至 1992
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-03670728/
• 关键词: Septic encephalopathy; Electroencephalogram; Multiple organ failure; Amino acid metabolism; Luminol-dependent chemiluminescence; Neutrophile; Bifemelane HCI; ケミルミネッセンス; 聴覚誘発電位; 経頭蓋的超音波ドップラ-; 内頚静脈酸素飽和度

In central nervous system(CNS)dysfunction observed in septic patients,septic encephalopathy,the authors have examined cerebral circulation and metabolism,and their relation to pathophysiologic derangement of hepatic/renal function and amino acid metabolism.Furthermore,they have measured phagocytic activity of neutrophiles in blood samples obtained from septic pateints.The results and their implications are as follows; 1.Cerebral circulation/metabolism and organ failure in septic encephalopathy Nineteen patients with septic encephalopathy were divided into two groups according to Hockaday's classification of electroencephalogram(EEG).In pateints whose EEG was classified as grade III-IV,the latency of wave V in auditory evoked response(ABR)was significantly lengthened than that in patients whose EEG was classified as grade I-II. Thus, both cerebral and brain stem electric activities are similarly affected by septic encephalopathy.Results in the measurement of cerebral blood flow,metaboli … More c rate for oxygen,and flow velocity of the middle cerebral artery using transcranial Doppler sonography indicated the impaired circulation and the decreased metabolic activity of the septic brain.In those patients,severe abnormalities in hepatic function(prothrombine time;PT),renal function(serum creatinine level;S-Cre),hemostasis(Platelet count;PLT),and amino acid metabolism(Fisher's ratio;FR)were observed.When those results were statistically analyzed with EEG findings using the stepwise multiple regression,the combination of factors most significantly correlated to EEG abnormality was revealed FR and S-Cre.This may imply that septic encephalopathy is a CNS manifestation of septic multiple organ failure.Of four patients who received bifemelane HCI in order to improve sustained impairment of consciousness level,two patients partially regained consciousness.Clinical study upon the beneficial effect of bifemerane HCI is warranted.2.Phagocytotic activity of neutrophiles in septic patients Luminol-dependent chemiluminescence(CL)was measured in the whole blood sample.Between healthy volunteers (n=10)and septic patients(n=11)in the acute ICU setting,white blood cell count(WBC),neutrophile count(Large cell fraction measured using Toa Iryo Densi Co.SYSMEX;LCC),peak chemiluminescence activity(pCL),time to peak CL (TP),and pCL/LCC were compared.As a result,in septic patients,averaged phagocytic activity for 10^6 neutrophiles represented by pCL/LCC was significantly enhanced,compared to that in healthy volunteers,in addition to an increase in WBC&LCC.Further study is necessary to clarify the relation between neutrophile CL,EEG,and organ function. Less

在脓毒性脑病患者中观察到中枢神经系统功能障碍，作者检查了脑循环和脑代谢，以及它们与肝肾功能和氨基酸代谢的病理生理紊乱的关系。此外，他们还测量了脓毒症患者血液样本中嗜中性粒细胞的吞噬活性。研究结果及其启示如下：1.脓毒性脑病的脑循环/代谢和器官衰竭19例脓毒性脑病患者按照Hockaday脑电图（EEG）分类分为两组。脑电分级为III-IV级的患者，听觉诱发反应（ABR） V波潜伏期明显长于脑电分级为I-II级的患者。因此，化脓性脑病对大脑和脑干电活动的影响相似。结果经颅多普勒超声测量脑血流量、代谢速率、血氧率、大脑中动脉血流速度显示脓毒性脑循环受损，代谢活性降低。在这些患者中，观察到肝功能（凝血酶原时间；PT）、肾功能（血清肌酐水平；S-Cre）、止血（血小板计数；PLT）和氨基酸代谢（Fisher’s ratio；FR）的严重异常。将这些结果与脑电图结果进行逐步多元回归统计分析，发现与脑电图异常相关最显著的因素组合为FR和S-Cre。这可能暗示感染性脑病是感染性多器官衰竭的中枢神经系统表现。为了改善意识水平的持续性损害，4例患者接受双美炔HCI治疗，2例患者部分恢复意识。双双体HCI的有益效果值得临床研究。采用全血鲁米诺依赖性化学发光法测定脓毒症患者嗜中性粒细胞的吞噬活性。在健康志愿者（n=10）和急性ICU脓毒症患者（n=11）之间，比较白细胞计数（WBC）、中性粒细胞计数（使用Toa Iryo Densi公司sysmex；LCC测量的大细胞分数）、峰值化学发光活性（pCL）、峰值CL时间（TP）和pCL/LCC。结果，在脓毒症患者中，与健康志愿者相比，以pCL/LCC为代表的10^6中性粒细胞的平均吞噬活性显著增强，白细胞和LCC也有所增加。中性粒细胞CL、脑电图和器官功能之间的关系有待进一步研究。少