Ortiz Leyba C
Servicio de Cuidados Críticos y Urgencias. Hospital Universitario Virgen del Rocío, Sevilla.
Nutr Hosp. 2006 May;21 Suppl 3:114-7.
The use of drugs for treating neuromuscular impairments that present in the patient admitted to the Intensive Care Unit is virtually inexistent. The use of intravenous immunoglobulins for managing polyneuropathy of the critically ill patient (PCIP) is supported by no evidence. More important is prophylactic therapy, as is the administration of insulin perfusion to prevent hyperglycemia that is associated to increased development of PCIP. New data suggest that the protective mechanism of this perfusion, which normalizes glucose levels, is achieved through the modulation of endothelial dysfunction and lowering levels of asymmetrical di-methyl arginine (ADMA). As for myopathy of the critically ill patient or conditions with prolonged neuromuscular blockade, treatment consists in avoiding the use of several drugs known to be associated with development of these conditions, such as muscle relaxants and aminoglycosides. In relation to acute flaccid paralysis -an infection caused by the Western Nile Virus, anecdotic cases have been reported of improvement with the use steroids or interferon, although routine management remains to be established.
在重症监护病房收治的患者中，几乎不存在使用药物治疗神经肌肉损伤的情况。目前没有证据支持使用静脉注射免疫球蛋白来治疗重症患者的多发性神经病（PCIP）。更重要的是预防性治疗，例如给予胰岛素灌注以预防与PCIP发生率增加相关的高血糖。新数据表明，这种使血糖水平正常化的灌注的保护机制是通过调节内皮功能障碍和降低不对称二甲基精氨酸（ADMA）水平来实现的。至于重症患者的肌病或神经肌肉阻滞持续时间较长的情况，治疗方法包括避免使用已知与这些情况发生相关的几种药物，如肌肉松弛剂和氨基糖苷类药物。关于急性弛缓性麻痹——一种由西尼罗河病毒引起的感染，有个别病例报告使用类固醇或干扰素后病情有所改善，尽管常规治疗方法仍有待确定。
