据10月27日刊《美国医学会杂志》上的一项研究披露，老年人在挺过了严重败血症之后更可能出现十分严重的认知损害和功能性残障。
根据文章的背景资料，美国每年都会有成千上万的病人得严重的败血症。文章的作者写道：“尽管严重败血症是最常见的非心源性的危重疾病，但人们却不知道严重败血症对认知功能和身体功能有何长期的影响。”
安阿伯密歇根大学医学院的Theodore J. Iwashyna, M.D., Ph.D.及其同事对疾病幸存者在发生一次严重的败血症之后是否会增加随后的认知损害和功能丧失的几率进行了调查。这项研究包括了来自健康与退休研究（Health and Retirement Study）中的因为严重败血症而导致的1520次住院的1194名患者，该项研究是一个对美国居民所做的有全国代表性的调查（1998-2006）。在研究开始的时候，总共有9223位回应者接受了认知和功能评估，他们还与医疗照顾索赔发生关联；有526人挺过了严重的败血症，有4517人挺过了一次非败血症的住院并接受了至少一次的随访调查，他们都被纳入到了本分析的报告之中。病人所存在的认知损害是以日常生活活动（ADLs）及工具性日常生活活动(IADLs，即病人需要工具的帮助)的次数来评估的。这些疾病幸存者在住院时的平均年龄为76.9岁。
研究人员发现，在那些挺过了严重败血症的病人中，其中度至重度认知能力损害的发生率增加了10.6个百分点，而他们罹患中度至重度认知能力损害的几率增加了3.3倍。同时，在那些没有或只有轻度至中度预先就有功能受限的患者中，在发生败血症之后，他们出现新的功能性受限的发生率很高，每位病人的新增功能性受限的平均值额外增加了1.5倍。
在非败血症性的一般性住院与中度至重度认知损害没有发生变化及出现较少的新的功能性受限具有相关性。
“在严重败血症之后所见的认知能力与功能下降的幅度与照料人员所花的时间显着增加、入住疗养院、抑郁症和死亡率的增加有关。这些数据指出，挺过败血症之后的负担是一个相当大的、被人们认识不足的公共卫生问题，它与病人、病人家庭及医疗系统都有很大的关系。”
文章的作者补充说，鉴于所发表的在美国的那些65岁或以上的人中的有关痴呆症和败血症的发病率，他们的结果提示，每年有近2万例新发生的老年人的中度至重度的认知损害可能是由败血症造成的。 “因此，发生一次严重的败血症，即使病人幸存了下来，它也代表了病人及其家庭生活中的一次警讯事件，它会导致新的而且常常是持续性的能力丧失，在某些病例中甚至会出现类似痴呆症的能力丧失。”
推荐英文摘要：
JAMA. 2010;304(16):1787-1794. doi:10.1001/jama.2010.1553
Long-term Cognitive Impairment and Functional Disability Among Survivors of Severe Sepsis
Theodore J. Iwashyna, MD, PhD; E. Wesley Ely, MD, MPH; Dylan M. Smith, PhD; Kenneth M. Langa, MD, PhD
Context Cognitive impairment and functional disability are major determinants of caregiving needs and societal health care costs. Although the incidence of severe sepsis is high and increasing, the magnitude of patients' long-term cognitive and functional limitations after sepsis is unknown.
Objective To determine the change in cognitive impairment and physical functioning among patients who survive severe sepsis, controlling for their presepsis functioning.
Design, Setting, and Patients A prospective cohort involving 1194 patients with 1520 hospitalizations for severe sepsis drawn from the Health and Retirement Study, a nationally representative survey of US residents (1998-2006). A total of 9223 respondents had a baseline cognitive and functional assessment and had linked Medicare claims; 516 survived severe sepsis and 4517 survived a nonsepsis hospitalization to at least 1 follow-up survey and are included in the analysis.
Main Outcome Measures Personal interviews were conducted with respondents or proxies using validated surveys to assess the presence of cognitive impairment and to determine the number of activities of daily living (ADLs) and instrumental ADLs (IADLs) for which patients needed assistance.
Results Survivors' mean age at hospitalization was 76.9 years. The prevalence of moderate to severe cognitive impairment increased 10.6 percentage points among patients who survived severe sepsis, an odds ratio (OR) of 3.34 (95% confidence interval [CI], 1.53-7.25) in multivariable regression. Likewise, a high rate of new functional limitations was seen following sepsis: in those with no limits before sepsis, a mean 1.57 new limitations (95% CI, 0.99-2.15); and for those with mild to moderate limitations before sepsis, a mean of 1.50 new limitations (95% CI, 0.87-2.12). In contrast, nonsepsis general hospitalizations were associated with no change in moderate to severe cognitive impairment (OR, 1.15; 95% CI, 0.80-1.67; P for difference vs sepsis = .01) and with the development of fewer new limitations (mean among those with no limits before hospitalization, 0.48; 95% CI, 0.39-0.57; P for difference vs sepsis &.001 and mean among those with mild to moderate limits, 0.43; 95% CI, 0.23-0.63; P for difference = .001). The declines in cognitive and physical function persisted for at least 8 years.
Conclusions Severe sepsis in this older population was independently associated with substantial and persistent new cognitive impairment and functional disability among survivors. The magnitude of these new deficits was large, likely resulting in a pivotal downturn in patients' ability to live independently
