脓毒症可出现永久性认知功能及脑功能损伤
一项多国联合研究显示，对于从重症监护病房（ICU）出院的患者，无论其是否罹患脓毒症，均可出现多个脑区永久性认知功能损害及非特异性脑功能障碍。与健康对照相比，脓毒症幸存者常出现左侧海马萎缩。医生应对ICU患者进行神经保护治疗，避免发生持久的脑功能改变。论文将发表于《神经病学、神经外科学与精神病学杂志》[J Neurol Neurosurg Psychiatry 2013，84（1）：62]。
研究者选取从ICU出院的脓毒症（n=25）和非脓毒症（n=19）患者，并以现有数据库中的健康者作为对照，随访6~24个月，进行脑部形态学、标准脑电图（EEG）、认知与精神健康状况以及健康相关的生活质量评估。
结果为，与健康对照组相比，脓毒症幸存者存在语言学习和记忆方面认知功能损害，且其左侧海马体积明显缩小。此外，脓毒症幸存者以及某些非脓毒症幸存者会在EEG上表现较多的低频活动，提示存在非特异性脑功能障碍。未发现出院患者与健康对照在健康相关的生活质量、心理功能或抑郁症状（应作为混杂因素被排除）方面存在差异。
Persistent cognitive impairment, hippocampal atrophy and EEG changes in sepsis survivors
Objectives
The objective of this preliminary study was to explore long-term changes in neurobehavioral parameters, brain morphology and electroencephalography of sepsis patients who received intensive care compared to non-septic intensive care unit (ICU) patients.
Methods
Two-centre follow-up study 6–24??months after discharge from hospital using published norms and existing databases of healthy controls for comparison. Patients included 25 septic and 19 non-septic ICU survivors who were recruited from two ICUs of a university and community hospital. Measurements used include brain morphology, standard electroencephalography, cognition and psychiatric health and health-related quality of life.
Results
Sepsis survivors showed cognitive deficits in verbal learning and memory and had a significant reduction of left hippocampal volume compared to healthy controls. Moreover, sepsis and to some extent non-septic ICU patients had more low-frequency activity in the EEG indicating unspecific brain dysfunction. No differences were found in health-related quality of life, psychological functioning or depressive symptoms, and depression could be ruled out as a confounding factor.
Conclusions
This study demonstrates permanent cognitive impairment in several domains in both septic and non-septic ICU survivors and unspecific brain dysfunction. In the sepsis group, left-sided hippocampal atrophy was found compared to healthy controls. Further study is needed to clarify what contribution sepsis and other factors at the ICU make to these outcomes. Specific neuroprotective therapies are warranted to prevent persisting brain changes in ICU patients.
