新冠放開不足半月，感染高峰期已經(jīng)暫告一段落，與此同時(shí)，另一新冠相關(guān)情況卻沖上熱搜，成為人們最關(guān)注的問題之一：新冠后遺癥。

衛(wèi)健委表示，我國(guó)疫情防控工作重心將從“防感染”轉(zhuǎn)向“保健康、防重癥”，而浙江等地更是新開了專門的“陽(yáng)康”門診，包括中醫(yī)養(yǎng)療和心理咨詢等，開始嘗試解決廣泛存在的新冠后遺癥問題。

很多讀者反映，為啥新冠“陽(yáng)康”后仿佛“失了智”？你沒有感覺錯(cuò)！這正是困擾了大多數(shù)“楊康”們的新冠后遺癥“腦霧”。今天，派派就為你詳細(xì)介紹，腦霧是什么、腦霧怎么辦。

其實(shí)“腦霧”并不是新詞，在之前便有相關(guān)的說法，2004年，“腦霧”的概念便已經(jīng)出現(xiàn)在了專業(yè)文獻(xiàn)中[1]，通俗來說，就是患者們覺得自己腦子里好像有迷霧籠罩，隔絕了思維和記憶。

而在之前的研究中，腦霧和基礎(chǔ)疾病有關(guān)，還和慢性應(yīng)激、睡眠不足、荷爾蒙變化（如妊娠或絕經(jīng)）、營(yíng)養(yǎng)不良、化療或病毒感染相關(guān)[2]。

新冠三年，“腦霧”這個(gè)詞迅速占據(jù)大眾視野，為此，世界衛(wèi)生組織也為“腦霧”重新設(shè)置了一個(gè)定義：

“腦霧”是急性COVID-19后患者常見智力功能主訴的非正式術(shù)語(yǔ)。這是一個(gè)總稱，用于解釋認(rèn)知功能障礙的集合，如意識(shí)模糊、短期記憶喪失、頭暈和無(wú)法集中注意力[3]。

根據(jù)臨床大數(shù)據(jù)調(diào)查，大多數(shù)人感覺到的腦霧是真實(shí)存在的，在“陽(yáng)康”們中，有約32%的人會(huì)出現(xiàn)腦霧的癥狀，僅次于疲勞[4]；但腦霧對(duì)康復(fù)患者生活的影響卻比疲勞更嚴(yán)重，甚至有的患者癥狀十分明顯，以至于無(wú)法正常工作。

圖注：包括腦霧在內(nèi)的多種精神類后遺癥的發(fā)病率和持續(xù)時(shí)長(zhǎng)

在不同“陽(yáng)康”身上，腦霧的程度也不一樣。感染期的癥狀越嚴(yán)重，則腦霧后遺癥也更嚴(yán)重；除此之外，腦霧的發(fā)病程度還和炎癥標(biāo)志物（例如IL-6和TNF-α）水平高[5]、女性、高齡、既往哮喘[6]、社會(huì)經(jīng)濟(jì)能力低、吸煙、肥胖等[7]因素密切相關(guān)。

一定有人存有疑惑，新冠是一個(gè)主要感染上呼吸道、損傷呼吸系統(tǒng)的疾病，為什么會(huì)造成大腦乃至全身方面的后遺癥呢？

目前的研究表明，新冠后遺癥的出現(xiàn)和五個(gè)關(guān)鍵因素有關(guān)：病毒的持久存在、激活其他病原體、誘導(dǎo)自身免疫、組織損傷誘發(fā)持續(xù)炎癥，以及微血栓的形成[8]。但是在腦霧后遺癥患者的腦脊液中并沒有檢測(cè)到病毒的存在[9]，因此，炎癥等其他損傷才是造成腦霧的主要原因。

No.1

全身炎癥

新冠病毒感染后免疫應(yīng)答，免疫細(xì)胞方能清除侵入人體的病毒，但是病毒清除完畢，免疫應(yīng)答帶來的副產(chǎn)品——炎癥卻并不打算隨之退場(chǎng)，因此全身性炎癥就成為了各種后遺癥的“罪魁禍?zhǔn)住敝弧?/p>

這在腦霧中自然也不例外。腦中的天然免疫細(xì)胞小膠質(zhì)細(xì)胞在新冠感染中被激活[10-11]，繼而產(chǎn)生大量促炎性細(xì)胞因子，誘導(dǎo)神經(jīng)炎癥，造成腦電圖的改變和海馬的萎縮[12]，從而產(chǎn)生記憶障礙、嗜睡、疲勞和失眠等癥狀[13]。

No.2

多種原因造成的缺氧/缺血

在新冠中，因?yàn)椴《镜母腥?，?nèi)皮功能障礙會(huì)導(dǎo)致血管損傷[14]，血栓和炎癥會(huì)導(dǎo)致毛細(xì)血管的堵塞[15]，彌漫性血管功能障礙會(huì)造成腦血流量的下降[16]。這些都會(huì)造成相似的后果：缺血和缺氧。大腦中的缺血和缺氧會(huì)造成腦白質(zhì)的損傷，繼而導(dǎo)致認(rèn)知功能障礙、記憶喪失等[17-18]。

圖注：造成腦霧等精神類后遺癥的主要原因[19]

上述病理性原因主要出現(xiàn)在較嚴(yán)重的新冠感染之后，但是輕度新冠患者也有可能出現(xiàn)腦霧的癥狀，他們則是受到了免疫失調(diào)、慢性炎癥、外周器官功能障礙[20]和代謝失調(diào)[21]等的影響，主要癥狀為焦慮和抑郁等。

腦霧在“陽(yáng)康”們中出現(xiàn)的概率這么大，那我們?cè)趺磻?yīng)對(duì)可能緊隨新冠而來的腦霧呢？我們需要科學(xué)的診斷和有效的治療。

No.1

腦霧的診斷

當(dāng)你剛從一場(chǎng)新冠感染中恢復(fù)過來，卻發(fā)現(xiàn)自己好像無(wú)法集中注意力、穩(wěn)定情緒或者和以往一樣記憶，那么你大概率就是患上了“腦霧”！當(dāng)然，如果感覺癥狀已經(jīng)嚴(yán)重到影響了正常生活和工作，則需要去醫(yī)院做影像學(xué)檢查、神經(jīng)絲輕鏈等進(jìn)一步醫(yī)療檢驗(yàn)[22]。

圖注：神經(jīng)性新冠后遺癥的診療算法[23]

No.2

腦霧的治療

腦霧帶來的影響對(duì)大多數(shù)人來說可能是有限的，但是盡可能通過治療緩解癥狀，就能盡可能縮小新冠后遺癥對(duì)生活的影響。

輕癥患者：行為和補(bǔ)劑干預(yù)

是藥三分毒，非藥物干預(yù)措施才是最安全的一線治療選擇，在應(yīng)對(duì)新冠后遺癥時(shí)也是如此。

通過有氧漸進(jìn)式運(yùn)動(dòng)訓(xùn)練計(jì)劃進(jìn)行身體修復(fù)；及時(shí)補(bǔ)充水和電解質(zhì)；小心避免可能加劇癥狀的情況（熬夜、出汗、喝酒或暴飲暴食）[24]。

還有一些更針對(duì)“腦霧”這一癥狀的行為訓(xùn)練，能較好地緩解新冠帶來的腦霧癥狀：

做增強(qiáng)記憶力的相關(guān)訓(xùn)練，以解決注意力不集中、無(wú)法記住常用詞和難以回憶前一天的事件等癥狀，例如做筆記、使用計(jì)劃器記錄信息以及將任務(wù)細(xì)分為小點(diǎn)以防止大腦疲勞；向記憶缺失的患者講述缺失部分記憶場(chǎng)景，幫助回憶；制定預(yù)防復(fù)發(fā)的行為計(jì)劃，包括制定日?；顒?dòng)清單等，保持精神活躍，減少自我批評(píng)，增加自我鼓勵(lì)[25]。

除此之外，一些日常補(bǔ)劑也在腦霧的改善中發(fā)揮著重要的作用。

1.褪黑素：根據(jù)臨床試驗(yàn)驗(yàn)證，褪黑素能顯著改善認(rèn)知能力、抑郁狀況和睡眠質(zhì)量，在每日0.15mg/kg的褪黑素干預(yù)下，腦霧患者的海馬萎縮、淀粉樣蛋白堆積等腦損傷情況得到了有效緩解[26]；

2.木犀草素：木犀草素具有廣泛的抗病毒活性，而且能很好地滲透到大腦中，抑制小膠質(zhì)細(xì)胞和肥大細(xì)胞，抑制神經(jīng)炎癥，減少認(rèn)知功能的下降，改善腦霧情況[27-28]；

3.來自迷迭香的鼠尾草酸（CA）：鼠尾草酸能通過抑制NLRP3炎癥小體來抑制活化的小膠質(zhì)細(xì)胞，有效抑制細(xì)胞因子風(fēng)暴，具有保護(hù)神經(jīng)和改善腦霧的潛力，且它僅在氧化和炎癥部位激活，具有良好的安全性[29]。

重癥患者：醫(yī)療干預(yù)和藥物治療

對(duì)于行為和補(bǔ)劑無(wú)法明顯改善的患者，則需要盡早就醫(yī)，并藥物干預(yù)，值得注意的是，任何精神類藥物都需要在醫(yī)生監(jiān)督下服用，即使在文獻(xiàn)或媒體中看到了對(duì)癥藥物，也不要輕易嘗試！

同時(shí)，即使是在醫(yī)囑下安全服用，這類藥物也不能長(zhǎng)期服用，它們的心血管副作用較高，會(huì)讓本就被新冠病毒損傷的心肌等雪上加霜。

———///———

看完上述對(duì)新冠后遺癥腦霧的詳細(xì)介紹，再面對(duì)腦霧的時(shí)候是不是既不會(huì)恐慌、也不會(huì)輕視了？

小小的腦霧，大大的影響，如果不幸被腦霧“選中了”也不要聽之任之，想要撥開腦子里的“迷霧”，恢復(fù)到新冠前的水平，還得需要我們對(duì)自己的健康負(fù)責(zé)，認(rèn)真做行為訓(xùn)練，小心選擇補(bǔ)劑和藥物，愿每一位讀者都能靈臺(tái)清明，無(wú)病無(wú)災(zāi)。

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