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重症监护病房获得性肌无力患者临床特征及神经电生理研究
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Abstract:
目的：分析探讨重症监护病房获得性肌无力(Intensive Care Unit Acquired Weakness, ICUAW)的临床、电生理特点。方法：对14例ICUAW患者的临床、电生理资料进行回顾性分析。结果：14例患者中男11例，女3例；发病年龄24~87岁，平均(57.57 ± 18.224)岁。其中危重病性多发性神经病(Critical Illness Polyneuropathy, CIP) 12例，危重病性肌病(Critical Illness Myopathy, CIM) 1例，危重病性多神经肌病(Critical Illness Polyneuromyopatlly, CIPNM) 1例。气管插管后呼吸机辅助呼吸8例，气管切开5例，鼻饲喂养12例，并发肺部感染13例，糖尿病患者3例，肌酸激酶升高者4例，全身炎症反应综合征(Systemic Inflammatory Response Svndrome, SIRS) 6例。所有患者均出现四肢无力并肌肉萎缩。肌电图示：运动神经末端潜伏期延长或未引出3例，运动神经复合肌肉动作电位(CMAP)波幅下降或未引出13例，四肢运动和感觉神经传导速度不同程度减慢或未引出9例，SNAP波幅下降8例，可见自发电位14例，F波潜伏期延长或出现率下降11例，H反射潜伏期延长或未引出9例。结论：ICUAW是危重症患者的常见并发症，临床、电生理的早期识别及判断有助于本病的诊断及治疗，提高患者疾病预后。
Objective: To analyze the clinical and electrophysiological phenotypes of the Intensive Care Unit-acquired Weakness (ICUAW). Methods: The clinical and electrophysiological data of 14 pa-tients with ICUAW were analyzed retrospectively. Results: Among the 14 patients, 11 were males and 3 were females. The average age of onset was (57.57 ± 18.224) years from 24 to 87 years. Among them, there were 12 cases of Critical Illness Polyneuropathy (CIP) and 1 case of Critical Ill-ness Myopathy (CIM). One case of Critical Illness Polyneuromyopatlly (CIPNM). There were 8 cases of ventilator-assisted breathing after endotracheal intubation, 5 cases of tracheotomy, 12 cases of na-sal feeding, 13 cases of pulmonary infection, 3 cases of diabetes, 4 cases of creatine kinase elevation, 6 cases of systemic inflammatory response svndrome (SIRS). All patients had limb weakness and muscle atrophy. Electromyography: The motor nerve terminal latency was prolonged or did not elicit in 3 cases, the motor nerve complex muscle action potential (CMAPs) amplitude decreased or did not elicit in 13 cases, the limb movement and sensory nerve conduction velocity slowed down or did not elicit in different degrees in 9 cases, SNAPs amplitude decreased in 8 cases, spontaneous potential was visible in 14 cases, and F-wave latency was prolonged or the occurrence rate de-creased in 11 cases. H reflex latency was prolonged or not elicited in 9 cases. Conclusion: ICUAW is a common complication in critically ill patients. Early clinical and electrophysiological recognition and judgment are helpful for the diagnosis and treatment of the disease and improve the prognosis of the patients.
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