Schweickert William D, Hall Jesse
Pulmonary/Critical Care, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, MC 6026, Chicago, IL 60657, USA.
Chest. 2007 May;131(5):1541-9. doi: 10.1378/chest.06-2065.
Observational studies of patients receiving prolonged mechanical ventilation and other forms of critical care support have determined acquired neuromuscular disorders to be extremely common. Early studies used electrophysiologic investigations to diagnose critical illness polyneuropathy (CIP) and muscle biopsy to confirm critical illness myopathy (CIM). More recent approaches seek to obviate these invasive techniques and build on a standardized bedside neuromuscular examination to identify patients with acquired weakness syndromes. Serial examination in the alert patient may serve as a reasonable prognosticator for most patients. The importance of ICU-acquired weakness syndromes is supported by the observation that muscle wasting and weakness are among the most prominent long-term complications of survivors of ARDS. In addition, a strong association appears to exist between acquired weakness and protracted ventilator dependence, an important determinant of ICU length of stay. Multivariate analysis has identified several risk factors associated with increased incidence for ICU-acquired weakness, including severe systemic inflammation, medications (specifically, corticosteroids and neuromuscular blocking agents), glycemic control, and immobility. We advocate an approach to this common syndrome that identifies risk factors early in the hope of minimizing their impact.
对接受长时间机械通气及其他形式重症监护支持的患者进行的观察性研究已确定，获得性神经肌肉疾病极为常见。早期研究采用电生理检查来诊断重症疾病多发性神经病（CIP），并通过肌肉活检来确诊重症疾病肌病（CIM）。最近的方法试图避免这些侵入性技术，并基于标准化的床边神经肌肉检查来识别患有获得性肌无力综合征的患者。对清醒患者进行连续检查可能对大多数患者来说是一种合理的预后指标。ICU获得性肌无力综合征的重要性得到了以下观察结果的支持：肌肉萎缩和无力是ARDS幸存者最突出的长期并发症之一。此外，获得性肌无力与长期呼吸机依赖之间似乎存在密切关联，而长期呼吸机依赖是ICU住院时间的一个重要决定因素。多变量分析已确定了几个与ICU获得性肌无力发病率增加相关的风险因素，包括严重的全身炎症、药物（特别是皮质类固醇和神经肌肉阻滞剂）、血糖控制和不动。我们提倡一种针对这种常见综合征的方法，即尽早识别风险因素，以期将其影响降至最低。
