Guarneri B, Bertolini G, Latronico N
Department of Neuroscience, Section of Clinical Neurophysiology, University of Brescia, Spedali Civili, Italy.
J Neurol Neurosurg Psychiatry. 2008 Jul;79(7):838-41. doi: 10.1136/jnnp.2007.142430. Epub 2008 Mar 13.
Critical illness myopathy (CIM) and polyneuropathy (CIP), alone or in combination (CIP/CIM), are frequent complications in patients in the intensive care unit (ICU). There is no evidence that differentiating between CIP and CIM has any impact on patient prognosis.
1-year prospective cohort study of patients developing CIP, CIM or combined CIP and CIM during ICU stay.
28 out of 92 (30.4%) patients developed electrophysiological signs of CIP and/or CIM during their ICU stay, which persisted in 18 patients at ICU discharge. At hospital discharge, diagnoses in the 15 survivors were CIM in six cases, CIP in four, combined CIP and CIM in three and undetermined in two uncooperative patients. During the 1-year follow-up of six patients with CIM, one patient died and five recovered completely within 3 (three patients) to 6 (two patients) months. Of three patients with CIP/CIM, one died, one recovered and one with residual CIP remained tetraplegic. Of four patients with CIP, one recovered, two had persisting muscle weakness and one remained tetraparetic.
CIM has a better prognosis than CIP. Differential diagnosis is important to predict long-term outcome in ICU patients.
危重病性肌病（CIM）和多发性神经病（CIP）单独或合并出现（CIP/CIM）是重症监护病房（ICU）患者常见的并发症。目前尚无证据表明区分CIP和CIM对患者预后有任何影响。
对在ICU住院期间发生CIP、CIM或合并CIP和CIM的患者进行为期1年的前瞻性队列研究。
92例患者中有28例（30.4%）在ICU住院期间出现了CIP和/或CIM的电生理体征，其中18例在ICU出院时仍存在。出院时，15例存活患者的诊断为：6例为CIM，4例为CIP，3例为CIP合并CIM，2例不合作患者诊断未明确。在对6例CIM患者进行的1年随访中，1例死亡，5例在3个月（3例患者）至6个月（2例患者）内完全康复。3例CIP/CIM患者中，1例死亡，1例康复，1例遗留CIP仍为四肢瘫痪。4例CIP患者中，1例康复，2例持续存在肌无力，1例仍为四肢轻瘫。
CIM的预后优于CIP。鉴别诊断对于预测ICU患者的长期预后很重要。
