神经电生理技术在脓毒症相关性脑病中的应用

余　敏; 詹　青

doi:10.12022/jnnr.2017-0024

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神经病学与神经康复学杂志 ›› 2017, Vol. 13 ›› Issue (2) : 80-84. DOI: 10.12022/jnnr.2017-0024

综述

神经电生理技术在脓毒症相关性脑病中的应用

余　敏，詹　青

作者信息 +

Application of neuro-electrophysiological techniques in sepsis-associated encephalopathy

YU Min, ZHAN Qing

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文章历史 +

摘要

脓毒症相关性脑病（sepsis-associated encephalopathy，SAE）是指由全身性炎性反应引起的一种弥漫性大脑功能障碍，在临床上常被漏诊。目前，仍缺乏统一而确定的SAE诊断标准，其诊断主要依据于临床表现、电生理检查及神经影像学检查。神经电生理技术可早于计算机断层摄影术（computed tomography，CT）和磁共振成像（magnetic resonance imaging，MRI）等影像学检查监测到SAE患者病情的变化，且具有无创性、可重复进行床旁操作以及快捷的优点。本文对脑电图或连续脑电图监测、体感诱发电位、经颅多普勒超声等神经电生理技术在SAE中的应用进展进行综述。

Abstract

Sepsis-associated encephalopathy (SAE) is a diffuse dysfunction of brain caused by systemic inflammation. It is often missed in clinical practice. At present, there is still a lack of unified and definite diagnostic criteria for SAE. The diagnosis is mainly based on clinical manifestations and electrophysiological and neuroimaging findings. As compared with computed tomography (CT) and magnetic resonance imaging (MRI), the changes of the disease in patients with SAE can be observed earlier by neuro-physiological techniques which are noninvasive and quick and the bedside operation can be conducted repeatedly. This paper reviews the progress in electroencephalogram and continuous electroencephalogram monitoring, somatosensory evoked potential, transcranial Doppler sonography and other neuro-physiological techniques in SAE.

关键词

Key words

Sepsis-associated encephalopathy / Neuro-electrophysiological techniques / Continuous electroencephalogram monitoring / Video electroencephalogram monitoring / Somatosensory evoked potential / Transcranial Doppler sonography

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导出引用

余　敏，詹　青. 神经电生理技术在脓毒症相关性脑病中的应用[J]. 神经病学与神经康复学杂志. 2017, 13(2): 80-84 https://doi.org/10.12022/jnnr.2017-0024

YU Min, ZHAN Qing. Application of neuro-electrophysiological techniques in sepsis-associated encephalopathy[J]. Journal of Neurology and Neurorehabilitation. 2017, 13(2): 80-84 https://doi.org/10.12022/jnnr.2017-0024

参考文献

[1] Wilson JX, Young GB. Progress in clinical neurosciences: sepsis-associated encephalopathy: evolving concepts[J]. Can J Neurol Sci, 2003, 30(2):98-105.
[2] Chaudhry N, Duggal AK. Sepsis associated encephalopathy[J]. Adv Med, 2014:762320. doi: 10.1155/2014/762320.
[3] Bartynski WS, Boardman JF, Zeigler ZR, et al. Posterior reversible encephalopathy syndrome in infection, sepsis, and shock[J]. AJNR Am J Neuroradiol, 2006, 27(10):2179-2190.
[4] Eidelman LA, Putterman D, Putterman C, et al. The spectrum of septic encephalopathy: Definitions, etiologies, and mortalities[J]. JAMA, 1996, 275(6):470-473.
[5] Gofton TE, Young GB. Sepsis-associated encephalopathy[J]. Nat Rev Neurol, 2012, 8(10):557-566.
[6] 李　鑑, 刘景峰, 段美丽. 脓毒症相关性脑病的流行病学分析[J]. 医学综述, 2017, 23(1):141-144.
[7] Polito A, Eischwald F, Maho AL, et al. Pattern of brain injury in the acute setting of human septic shock[J]. Crit Care, 2013, 17(5):R204.
[8] Sutter R, Stevens RD, Kaplan PW. Clinical and imaging correlates of EEG patterns in hospitalized patients with encephalopathy[J]. J Neurol, 2013, 260(4):1087-1098.
[9] Schramm P, Klein KU, Falkenberg L, et al. Impaired cerebrovascular autoregulation in patients with severe sepsis and sepsis-associated delirium[J]. Crit Care, 2012, 16(5):R181.
[10] Taccone FS, Su F, Pierrakos C, et al. Cerebral microcirculation is impaired during sepsis: an experimental study[J]. Crit Care, 2010, 14(4):R140.
[11] Kafa IM, Bakirci S, Uysal M, et al. Alterations in the brain electrical activity in a rat model of sepsis-associated encephalopathy[J]. Brain Res, 2010, 1354:217-226.
[12] Young GB, Bolton CF, Archibald YM, et al. The electroencephalogram in sepsis-associated encephalopathy[J]. J Clin Neurophysiol, 1992, 9(1):145-152.
[13] Cotena S, Piazza O. Sepsis-associated encephalopathy[J]. Transl Med UniSa, 2012, 2:20-27.
[14] Claassen J, Hirsch LJ, Emerson RG, et al. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review[J]. Epilepsia, 2002, 43(2):146-153.
[15] 王勤鹰, 余　敏, 詹　青, 等. 视频脑电图和体感诱发电位在昏迷患者中的应用[J]. 神经病学与神经康复学杂志, 2013, 10(4):188-191.
[16] Judson JA, Cant BR, Shaw NA. Early prediction of outcome from cerebral trauma by somatosensory evoked potentials[J]. Crit Care Med, 1990, 18(4):363-368.
[17] Zentner J, Rohde V. The prognostic value of somatosensory and motor evoked potentials in comatose patients[J]. Neurosurgery, 1992, 31(3):429-434.
[18] 赵　红, 宿英英, 丁　宁. 两种体感诱发电位分级标准对重症脑功能损伤预后预测的比较[J]. 脑与神经疾病杂志, 2014, 22(3):171-174.
[19] Zauner C, Gendo A, Kramer L, et al. Impaired subcortical and cortical sensory evoked potential pathways in septic patients[J]. Crit Care Med, 2002, 30(5):1136-1139.
[20] 张晓婷, 张建龙, 马　琪, 等. 脓毒症过程中大鼠皮层诱发电位的变化[J]. 新疆医科大学学报, 2006, 29(5):401-403.
[21] 宋合保, 高国一, 冯军峰, 等. N20体感诱发电位监测对颅脑创伤昏迷患者的预后判断价值[J]. 上海交通大学学报（医学版）, 2016, 36(8):1196-1200.
[22] 王齐芳, 刘　榕, 韩家裕, 等. SAE患者脑血流速度和脑电活动变化及临床意义[J]. 赣南医学院学报, 2014, 34(3):398-399.
[23] 项　丹, 曾其毅. 脓毒症相关性脑病发病机制研究进展[J]. 中国实用儿科杂志, 2015, 30(7):550-555.
[24] Schramm P, Klein KU, Falkenberg L, et al. Impaired cerebrovascular autoregulation in patients with severe sepsis and sepsis-associated delirium[J]. Crit Care, 2012, 16(5):R181.
[25] Berg RM, Plovsing RR, Ronit A, et al. Disassociation of static and dynamic cerebral autoregulatory performance in healthy volunteers after lipopolysaccharide infusion and in patients with sepsis[J]. Am J Physiol Regul Integr Comp Physiol, 2012, 303(11):R1127-R1135.
[26] Lemiale V, Huet O, Vigué B, et al. Changes in cerebral blood flow and oxygen extraction during post-resuscitation syndrome[J]. Resuscitation, 2008, 76(1):17-24.
[27] Lewis LM, Stothert JC Jr, Gomez CR, et al. A noninvasive method for monitoring cerebral perfusion during cardiopulmonary resuscitation[J]. J Crit Care, 1994, 9(3):169-174.
[28] Czosnyka M, Matta BF, Smielewski P, et al. Cerebral perfusion pressure in head-injured patients: a noninvasive assessment using transcranial Doppler ultrasonographyJ]. J Neurosurg, 1998, 88(5):802-808.