Ahlbeck K, Fredriksson K, Rooyackers O, Måbäck G, Remahl S, Ansved T, Eriksson L, Radell P
Department of Physiology and Pharmacology, Section for Anaesthesiology and Intensive Care Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
Acta Anaesthesiol Scand. 2009 Jul;53(6):717-23. doi: 10.1111/j.1399-6576.2009.01952.x. Epub 2009 Apr 14.
Critical illness polyneuropathy and myopathy (CIPNM) is recognized as a common condition that develops in the intensive care unit (ICU). It may lead to a prolonged hospital stay with subsequent increased ICU and hospital costs. Knowledge of predisposing factors is insufficient and the temporal pattern of CIPNM has not been well described earlier. This study investigated patients with critical illness in need of prolonged mechanical ventilation, describing comprehensively the time course of changes in muscle and nerve neurophysiology, histology and mitochondrial oxidative function.
Ten intensive care patients were investigated 4, 14 and 28 days after the start of mechanical ventilation. Laboratory tests, neurophysiological examination, muscle biopsies and clinical examinations were performed. Neurophysiological criteria for CIPNM were noted and measurements for mitochondrial content, mitochondrial respiratory enzymes and markers of oxidative stress were performed.
While all patients showed pathologic changes in neurophysiologic measurements, only patients with sepsis and steroid treatment (5/5) fulfilled the CIPNM criteria. The presence of CIPNM did not affect the outcome, and the temporal pattern of CIPNM was not uniform. All CIP changes occurred early in ICU care, while myopathy changes appeared somewhat later. Citrate synthase was decreased between days 4 and 14, and mitochondrial superoxide dismutase was increased.
With comprehensive examination over time, signs of CIPNM can be seen early in ICU course, and appear more likely to occur in patients with sepsis and corticosteroid treatment.
危重病性多发性神经病和肌病（CIPNM）被认为是重症监护病房（ICU）中常见的病症。它可能导致住院时间延长，进而增加ICU和医院的费用。目前对其易感因素的了解不足，且CIPNM的时间模式此前尚未得到充分描述。本研究对需要长时间机械通气的危重病患者进行了调查，全面描述了肌肉和神经神经生理学、组织学以及线粒体氧化功能的变化时间进程。
对10名重症监护患者在机械通气开始后的第4天、第14天和第28天进行了调查。进行了实验室检查、神经生理学检查、肌肉活检和临床检查。记录了CIPNM的神经生理学标准，并对线粒体含量、线粒体呼吸酶和氧化应激标志物进行了测量。
虽然所有患者在神经生理学测量中均显示出病理变化，但只有患有脓毒症且接受类固醇治疗的患者（5/5）符合CIPNM标准。CIPNM的存在并不影响预后，且CIPNM的时间模式并不一致。所有CIP变化均在ICU护理早期出现，而肌病变化出现得稍晚。柠檬酸合酶在第4天至第14天之间下降，线粒体超氧化物歧化酶增加。
通过长时间的全面检查，可在ICU病程早期发现CIPNM的迹象，且脓毒症和接受皮质类固醇治疗的患者更易出现。
