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

在败血症患者中枢神经系统(CNS)功能障碍方面，作者研究了脑循环和代谢及其与肝肾功能病理生理紊乱和氨基酸代谢的关系，并测定了脓毒症患者血液中中性粒细胞的吞噬活性。结果及意义如下：1.感染性脑病的脑循环/代谢与器官功能衰竭19例感染性脑病患者按Hockaday脑电分类分为两组，脑电分级为III~IV级者，听觉诱发反应(ABR)V波潜伏期较I~II级者明显延长。因此，感染性脑病对大脑和脑干的电活动都有相似的影响。结果在测量脑血流量时，代谢物…在这些患者中，肝功能(凝血酶原时间；PT)、肾功能(血肌酐水平；S-肌酐)、止血(血小板计数；PLT)和氨基酸代谢(Fisher‘s比率；当这些结果与脑电结果用逐步多元回归进行统计分析时，发现与脑电异常最显著相关的因素组合为FR和S-Create。这可能暗示败血症脑病是败血症多器官衰竭的中枢神经系统表现。在为改善持续性意识水平损害而接受联苯美仑治疗的4名患者中，有2名患者部分恢复意识。临床研究证实了联苯美仑的疗效。2.在急性ICU环境下，测定了脓毒症患者中性粒细胞吞噬活性，鲁米诺依赖的化学发光(CL)。在健康志愿者(n=10)和脓毒症患者(n=11)之间白细胞计数(WBC)、中性粒细胞计数(用TOA Iryo Densi Co.SYSMEX测量大细胞比例；结果表明，在脓毒症患者中，以PCL/LCC为代表的10^6个中性粒细胞的平均吞噬活性显著高于健康志愿者，WBC和LC也明显增加，中性粒细胞CL、EEG和器官功能之间的关系有待进一步研究。较少

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