脓毒症相关性脑病六例诊断分析

Diagnosis of sepsis associated encephalopathy：a retrospective analysis of 6 patients

目的：探讨有感染证据并伴有昏迷的6例脓毒症相关性脑病（sepsis associated encephalopathy， SAE）的诊断。方法2013年1月至2014年10月，采用全身炎症反应综合征（systemic inflammatory response syndrome，SIRS）阳性脓毒症相关性脑病的诊断标准对来自沭阳县人民医院重症监护病房（ICU）的存在感染和昏迷的病例进行回顾性诊断。结果在6例有感染证据的昏迷患者中，3例为出血性卒中后继发感染，1例为脑外伤后继发感染，另2例为原发性感染。所有患者均符合 SIRS-阳性脓毒症相关性脑病的诊断。其中，存在SIRS 3项标准者2例，4项标准者4例。除了急性肺损伤所致呼吸衰竭者5例和急性肝衰1例外，所有患者伴有严重脑功能衰竭（100％）。脑影像证实，2例（33．3％）表现为迟发性血管源脑水肿，4例（66．7％）为脑缺血性损害，包括轻微梗塞和轻微白质损害各1例（伴有良好的预后）及严重白质损害2例（1例为多灶性白质脑病伴有脑桥中央髓鞘溶解症和1例为广泛性白质损害，预后差）。结论脓毒症相关性脑病是常见的危重症，采用 SIRS 分类脓毒症诊断标准有助于脓毒症相关性脑病的诊断。

Objective To investigate whether the presence of infection in a case series with coma would predict sepsis associated encephalopathy（SAE）.Methods From Jan 2013 to Oct 2014,we used the criteria of systemic inflammatory response syndrome （SIRS）positive sepsis with encephalopathy and retrospective diagnosed a comatose case series with infection and from a tertiary teaching hospital intensive care unit （ICU）.Results Among 6 comatose patients with evidence of infection,3 cases were secondary infection after hemorrhagic stroke,1 case was secondary infection after trauma,and the other 2 cases were primary infection.All patients met the diagnosis of SIRS -positive sepsis with encephalopathy.Among them,the presence of SIRS 3 criteria was in 2 cases,four criteria in 4 cases. All patients with severe brain failure （100%）,in addition to 5 cases with acute respiratory failure caused by lung injury,one case with acute liver failure.Brain imaging confirmed that the delayed vasogenic edema was in two cases （33.3%）,the cerebral ischemic lesions in four cases（66.7%）.The ischemic lesion included 1 patient with minor infarcts and 1 case with mild white matter lesions,and with a good prognosis.The other two ischemic cases included multifocal leukoencephalopathy with central pontine myelinolysis in 1 case and extensive white matter lesions in 1 case,eventually with a poor prognosis.Conclusion SAE is a common critically illness,the use of the new classifi-cation criteria of sepsis is helpful in the diagnosis of sepsis associated encephalopathy.