一項(xiàng)多國(guó)聯(lián)合研究顯示，對(duì)于從重癥監(jiān)護(hù)病房（ICU）出院的患者，無(wú)論其是否罹患膿毒癥，均可出現(xiàn)多個(gè)腦區(qū)永久性認(rèn)知功能損害及非特異性腦功能障礙。與健康對(duì)照相比，膿毒癥幸存者常出現(xiàn)左側(cè)海馬萎縮。醫(yī)生應(yīng)對(duì)ICU患者進(jìn)行神經(jīng)保護(hù)治療，避免發(fā)生持久的腦功能改變。論文將發(fā)表于《神經(jīng)病學(xué)、神經(jīng)外科學(xué)與精神病學(xué)雜志》[J Neurol Neurosurg Psychiatry 2013，84（1）：62]。

　　研究者選取從ICU出院的膿毒癥（n=25）和非膿毒癥（n=19）患者，并以現(xiàn)有數(shù)據(jù)庫(kù)中的健康者作為對(duì)照，隨訪6~24個(gè)月，進(jìn)行腦部形態(tài)學(xué)、標(biāo)準(zhǔn)腦電圖（EEG）、認(rèn)知與精神健康狀況以及健康相關(guān)的生活質(zhì)量評(píng)估。

　　結(jié)果為，與健康對(duì)照組相比，膿毒癥幸存者存在語(yǔ)言學(xué)習(xí)和記憶方面認(rèn)知功能損害，且其左側(cè)海馬體積明顯縮小。此外，膿毒癥幸存者以及某些非膿毒癥幸存者會(huì)在EEG上表現(xiàn)較多的低頻活動(dòng)，提示存在非特異性腦功能障礙。未發(fā)現(xiàn)出院患者與健康對(duì)照在健康相關(guān)的生活質(zhì)量、心理功能或抑郁癥狀（應(yīng)作為混雜因素被排除）方面存在差異。

　　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.

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