Vilas E, Fernández J M, Navarro C, Suárez L, García de Lorenzo A
Servicio de Anestesiología, Reanimación y Unidad del Dolor, Complexo Hospitalario Universitario, de Vigo, Pontevedra, España.
Rev Neurol. 2006;42(11):674-80.
To analyse the causes and signs of the muscle weakness that critically ill patients develop during their stay in the ICU and to review the literature.
In the early 80s, Bolton reported a mixed axonal polyneuropathy that he called 'polyneuropathy in critically ill patients'. Clinically it was characterised by muscle weakness that varied in intensity and caused quadriplegia and/or the need for assisted ventilation in its severest forms. It is currently considered to be the most common neurological disorder among critically ill patients. Many patients made a complete recovery after a few months or even a year. Running almost parallel to this, he also described 'acute myopathy in intensive care' among asthmatic patients who were hospitalised in the ICU due to exacerbation of their illness. It was later observed how other types of patients also had this myopathy, for instance, those who had undergone a transplant, sepsis or burns. Some authors consider acute myopathy in intensive care to be the primary cause of muscle weakness in the ICU.
On many occasions 'polyneuropathy of critically ill patients' and 'acute myopathy in intensive care' can be differentiated and to do so neurophysiological and, if necessary, muscle biopsy studies are a valuable aid. Although some authors prefer to group these conditions under the name 'polyneuromyopathy', we propose the general term 'acquired neuromuscular syndrome in critically ill patients' -a more descriptive expression that does not presuppose a particular mechanism or a single aetiology.
分析重症患者在重症监护病房（ICU）住院期间发生肌肉无力的原因和体征，并对相关文献进行综述。
20世纪80年代初，博尔顿报告了一种混合性轴索性多发性神经病，他称之为“重症患者多发性神经病”。临床上其特征为肌肉无力，程度各异，最严重时可导致四肢瘫痪和/或需要辅助通气。目前它被认为是重症患者中最常见的神经疾病。许多患者在数月甚至一年后完全康复。与此同时，他还描述了因病情加重而入住ICU的哮喘患者中的“重症监护急性肌病”。后来发现其他类型的患者也有这种肌病，例如接受过移植、患有败血症或烧伤的患者。一些作者认为重症监护急性肌病是ICU中肌肉无力的主要原因。
在很多情况下，“重症患者多发性神经病”和“重症监护急性肌病”可以区分，神经生理学检查以及必要时的肌肉活检研究对此有很大帮助。尽管一些作者倾向于将这些情况归为“多神经病性肌病”，但我们建议使用通用术语“重症患者获得性神经肌肉综合征”——这是一个更具描述性的表达，不预先假定特定机制或单一病因。
