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中华重症医学电子杂志 ›› 2018, Vol. 04 ›› Issue (03) : 226 -230. doi: 10.3877/cma.j.issn.2096-1537.2018.03.004

所属专题: 重症医学 文献

专题笔谈

重症神经:脑与脑外器官
张丽娜1, 艾宇航1,()   
  1. 1. 410008 长沙,中南大学湘雅医院重症医学科
  • 收稿日期:2017-11-30 出版日期:2018-08-28
  • 通信作者: 艾宇航
  • 基金资助:
    国家自然科学基金项目(81401099;81671960)

Critical and neurointensive care: brain and other organs cross-talk

Lina Zhang1, Yuhang Ai1,()   

  1. 1. Department of Intensive Care Unit, Xiangya Hospital of Central South University, Changsha 410008, China
  • Received:2017-11-30 Published:2018-08-28
  • Corresponding author: Yuhang Ai
  • About author:
    Corresponding author: Ai Yuhang, Email:
引用本文:

张丽娜, 艾宇航. 重症神经:脑与脑外器官[J]. 中华重症医学电子杂志, 2018, 04(03): 226-230.

Lina Zhang, Yuhang Ai. Critical and neurointensive care: brain and other organs cross-talk[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2018, 04(03): 226-230.

重症神经是重症医学的重要分支,包含了重度颅脑损伤、脑卒中、蛛网膜下腔出血等原发性神经系统重症疾病和休克、严重脓毒症,成人急性呼吸窘迫综合征等非原发性神经系统疾病重症患者在治疗过程中出现的继发性神经功能损伤两部分内涵,是近年来重症领域研究热点与难点。重症神经患者病理生理改变复杂,脑与心脏、肺脏、肾脏、胃肠道、肝脏、胰腺、肾上腺等多个器官存在交互作用,疾病状态下常常相互影响导致多系统、多器官功能受损。理解脑与脑外器官交互作用将有助于理解疾病病理生理机制和决策治疗;基于脑与脑外器官交互作用理解基础上的监测与治疗是走向重症神经患者精准治疗的前提。

Critical and neurointensive care is an important branch of critical care medicine, including primary nervous system diseases, such as severe trauma brain injury, stroke, subarachnoid hemorrhage and non-primary diseases of nervous system with involvement brain dysfunction which induced by shock, severe sepsis, and ARDS et al, during the medical process. The pathophysiological changes of critical and neurointensive care patients are complicated, and often combine with multiple system and organ dysfunction. The brain interacted with heart, lung, kidney, gastrointestinal tract, liver, pancreas, adrenal gland and other organs. Cross-talk usually exists in the process of the disease. Understanding the interaction between brain and external organs rather than taking stop-gap measures, is helpful in recognition of the nature of diseases and decision-making, whereafter up to precise treatment.

图1 重症神经患者脑与脑外器官相互作用的临床表现
1
Fodstad H,Kelly PJ,Buchfelder M. History of the Cushing reflex [J]. Neurosurgery, 2006, 59(5): 1132-1137.
2
van der Bilt IA,Hasan D,Vandertop WP, et al. Impact of cardiac complicationson outcome after aneurysmal subarachnoid hemorrhage: a meta-analysis [J]. Neurology, 2009, 72(7): 635-642.
3
Hurst RT,Prasad A,Askew JW, et al. Takotsubo cardiomyopathy: a uniquecardiomyopathy with variable ventricular morphology [J]. JACC Cardiovasc Imaging, 2010, 3(6): 641-649.
4
Kono T,Morita H,Kuroiwa T, et al. Left ventricular wall motion abnormalities inpatients with subarachnoid hemorrhage: neurogenic stunned myocardium [J]. Am Coll Cardiol, 1994, 24(3): 636-640.
5
Bernstein R,Mayer SA,Magnano A. Neurogenic stunned myocardium inGuillain-Barre syndrome [J]. Neurology, 2000, 54(3): 759-762.
6
Silvani A,Calandra-Buonaura G,Dampney RAL, et al. Brain-heart interactions: physiology and clinical implications [J]. Phil Trans R Soc A, 2016, 374(2067). pii: 20150181.
7
Samuels MA. The brain-heart connection [J]. Circulation, 2007, 116(1): 77-84.
8
Baguley I,Heriseanu R,Cameron I, et al. A critical review of the pathophysiology of dysautonomia following traumatic brain injury [J]. Neurocrit Care, 2008, 8(2): 293-300.
9
Pelosi P,Ferguson ND,Frutos-Vivar F, et al. Management and outcome of mechanically ventilated neurologic patients [J]. Crit Care Med, 2011, 39(6): 1482-1492.
10
Hoesch RE,Lin E,Young M, et al. Acute lung injury in critical neurological illness [J]. Crit Care Med, 2012, 40(2): 587-593.
11
Fontes RB,Aguiar PH,Zanetti MV, et al. Acute neurogenic pulmonary edema: case reports and literature review [J]. J Neurosurg Anesthesiol, 2003, 15(2): 144-150.
12
Theodore J,Robin ED. Speculations on neurogenic pulmonary edema (NPE) [J]. Am Rev Respir Dis, 1976, 113(4): 405-411.
13
Keegan MT,Lanier WL. Pulmonary edema after resection of a fourth ventricle tumor: possible evidence for a medulla-mediated mechanism [J].Mayo Clin Proc, 1999, 74(3): 264-268.
14
Milbrandt EB,Angus DC. Potential mechanisms and markers of critical illness-associated cognitive dysfunction [J]. Curr Opin Crit Care, 2005, 11(4): 355-359.
15
Hopkins RO,Jackson JC. Long-term neurocognitive function after critical illness [J]. Chest, 2006, 130(3): 869-878.
16
Pustavoitau A,Stevens RD. Mechanisms of neurologic failure in critical illness [J]. Crit Care Clin, 2008, 24(1): 1-24.
17
Janz DR,Abel TW,Jackson JC, et al. Brain autopsy findings in intensive care unit patients previously suffering from delirium: a pilot study [J]. J Crit Care, 2010, 25(3): 538.e7-12.
18
Boone MD,Jinadasa SP,Mueller A, et al. The effect of positive end-expiratory pressure on intracranial pressure and cerebral hemodynamics [J]. Neurocrit Care, 2017, 26(2): 174-181.
19
Mascia L,Grasso S,Fiore T, et al. Cerebro-pulmonary interactions during the application of low levels of positive end-expiratory pressure [J]. Intensive Care Med, 2005, 31(3): 373.
20
Roth C,Ferbert A,Deinsberger W, et al.Does prone positioning increase intracranial pressure? A retrospective analysis of patients with acute brain injury and acute respiratory failure [J]. Neurocrit Care, 2014, 21(2): 186-191.
21
Afsar B,Sag AA,Yalcin CE, et al. Brain-kidney cross-talk: Definition and emerging evidence [J]. Eur J Intern Med, 2016, 36: 7-12.
22
Freeman WD,Wadei HM. A brain-kidney connection: the delicate interplay of brain and kidney physiology [J]. Neurocrit Care, 2015, 22(2): 173-175.
23
Davenport A. The brain and the kidney—organ cross talk and interactions [J]. Blood Purify, 2008, 26(6): 526-536.
24
Salama M,Farrag SM,Abulasrar S, et al. Up-regulation of TLR-4 in the brain after ischemic kidney-induced encephalopathy in the rat [J]. CNS Neurol Disord Drug Targets, 2013, 12(5): 583-586.
25
Ono M,Arnaoutakis GJ,Fine DM, et al. Blood pressure excursions below the cerebral auto-regulation threshold during cardiac surgery are associated with acute kidney injury [J]. Crit Care Med, 2013, 41(2): 464-471.
26
O′Rourke MF,Safar ME. Relationship between aortic stiffening and microvascular disease in brain and kidney: cause and logic of therapy [J].Hypertension, 2005, 46(1): 200-204.
27
Liu M,Liang Y,Chigurupati S, et al. Acute kidney injury leads to inflammation and functional changes in the brain [J]. J Am Soc Nephrol, 2008, 19(7): 1360-1370.
28
Nongnuch A,Panorchan K,Davenport A. Brain-kidney crosstalk [J]. Crit Care, 2014, 18(3): 225.
29
O′Kane RL,Viña JR,Simpson I, et al. Cationic amino acid transport across the blood-brain barrier is mediated exclusively by system y+ [J].Am J Physiol Endocrinol Metab, 2006, 291(2): E412-419.
30
Arieff AI,Massry SG,Barrientos A, et al. Brain water and electrolyte metabolism in uremia: effects of slow and rapid hemodialysis [J]. Kidney Int, 1973, 4(3): 177-187.
31
Fletcher JJ,Bergman K,Carlson G, et al. Continuous renal replacement therapy for refractory intracranial hypertension? [J]. J Trauma, 2010, 68(6): 1506-1509.
32
Lund A,Damholt MB,Strange DG, et al. Increased intracranial pressure during hemodialysis in a patient with anoxic brain injury [J]. Case Rep Crit Care, 2017, 2017: 5378928.
33
Duron E,Hanon O. Antihypertensive treatments, cognitive decline, and dementia [J]. J Alzheimers Dis, 2010, 20(3): 903-914.
34
Foster JA,McVey Neufeld KA. Gut-brain axis: How the microbiome influences anxiety and depression [J]. Trends Neurosci, 2013, 36(5): 305-312.
35
Mulak A,Bonaz B. Brain-gut-microbiota axis in Parkinson′s disease [J]. World J Gastroenterol, 2015, 21(37): 10609-10620.
36
Bailey MT,Dowd SE,Galley JD, et al. Exposure to a social stressor alters the structure of the intestinal microbiota: Implications for stressor-induced immunomodulation [J]. Brain Behav Immun, 2011, 25(3): 397-407.
37
Dinan TG,Stanton C,Cryan JF. Psychobiotics: A novel class of psychotropic [J]. Biol Psychiatry, 2013, 74(10): 720-726.
38
Dimopoulou I,Tsagarakis S,Kouyialis AT, et al. Hypothalamic-pituitary-adrenal axis dysfunction in critically ill patients with traumatic brain injury: incidence, pathophysiology, and relationship to vasopressor dependence and peripheral interleukin-6 levels [J]. Crit Care Med, 2004, 32(2): 404-408.
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