脓毒症相关性脑病.pptVIP

SAE 预后：本病大多数预后良好，迁延治疗或错误治疗会导致中枢神经系统不可逆损伤，留下神经系统后遗症。　 　 Sepsis is a disease of microcirculation dysfunction !! 脓毒症是微循环病 Coagulopathies disorders are also the feature of sepsis !! 凝血功能障碍也是脓毒症的特征 　 Sepsis : - Sepsis associated encephalopathy (SAE)脑 - Sepsis induced cardiac dysfunction心脏 - Inflammation- coagulation cross talk 凝血机制 - Bacterial Translocation ( from gut to the lung)胃肠道 - SIRS – Sepsis – MODS( kidney, heart, lung,liver Gastric – intestine, Blood system brain ect.) 多器官 Antibiotics induced sepsis ! Antibiotics mediated sepsis ! whereas SAE is considered a diffuse cerebral dysfunction as a consequence of the systemic inflammatory response to an infection with no direct central nervous system infestation. sepsis-associated encephalopathy (SAE), sepsis-associated delirium, or brain dysfunction Sepsis associated encephalopathy (SAE) is a severe complication of sepsis with an incidence ranging from 9% to 71%. Reciprocal interactions between the immune and central nervous systems (CNS) are now considered to be major components of the host response in septic shock. Because the CNS controls a wide range of physiological functions that are crucial to maintain homeostasis and orchestrate the host response at behavioral, neuroendocrine and autonomic levels, disturbances in any of these adaptive functions may deleteriously influence the course of septic shock. Contributing factors for the compromise of the BBB include cytokines and chemokines, activation of the complement cascade, phagocyte-derived toxic mediators, and bacterial products. Recent studies suggest that bacterial proteins may readily cross the functional BBB and trigger an inflammatory response in the subarachnoid space, in absence of a bacterial invasion. Experimental studies have shown that microcirculatory dysfunction, a consequence of endothelial activation, is an early pathogenic step. In 2006, the California encephalitis project, which evaluated 1570 p