Intensive Care Unit, Poissy, France.
Crit Care Med. 2009 Oct;37(10 Suppl):S309-15. doi: 10.1097/CCM.0b013e3181b6e64c.
Intensive care unit-acquired weakness, the main clinical sign of critical illness neuromyopathy, is an increasingly recognized cause of prolonged mechanical ventilation and delayed return to physical self-sufficiency. Identifying risk factors and developing preventive measures are therefore important goals. Several studies on risk factors for critical illness neuromyopathy including prospective observational studies with a multivariate analysis of potential risk factors were conducted over the last decade. A large body of data is also available from two large prospective randomized trials comparing the effect of strict vs. conventional blood-glucose control on intensive care unit mortality and on secondary outcomes including the occurrence of critical illness neuromyopathy. Five central risk factors and their related potential measures to prevent intensive care unit-acquired weakness can be identified including multiple organ failure, muscle inactivity, hyperglycemia, and use of corticosteroids and neuromuscular blockers. Although strong evidence regarding the efficacy of preventive measures is still lacking, the results of available studies are promising and cast doubt on the widespread belief that the treatment of intensive care unit-acquired weakness is essentially supportive. Early identifying and treating conditions leading to multiple organ failure, especially severe sepsis and septic shock, avoiding unnecessary deep sedation and excessive blood glucose levels, promoting early mobilization, and carefully weighing the risks and benefits of corticosteroids might contribute to reduce the incidence and severity of intensive care unit-acquired weakness.
重症加强护理病房获得性肌无力是危重病性肌病的主要临床特征，也是导致机械通气时间延长和身体恢复自理能力延迟的重要原因。因此，确定危险因素并制定预防措施是非常重要的目标。过去十年中，针对危重病性肌病的危险因素开展了几项研究，包括对潜在危险因素进行多变量分析的前瞻性观察性研究。此外，还有两项大型前瞻性随机试验提供了大量数据，比较了严格血糖控制与常规血糖控制对重症加强护理病房死亡率以及危重病性肌病等次要结局的影响。目前可以确定 5 个中心性危险因素及其相关的预防措施，包括多器官衰竭、肌肉失用、高血糖、皮质类固醇和神经肌肉阻滞剂的使用。尽管预防措施的疗效仍缺乏有力证据，但现有研究结果令人鼓舞，使人们对重症加强护理病房获得性肌无力的治疗主要是支持治疗的普遍观点产生了怀疑。早期识别和治疗导致多器官衰竭的情况，尤其是严重脓毒症和感染性休克，避免不必要的深度镇静和过高的血糖水平，促进早期活动，以及仔细权衡皮质类固醇的风险和益处，可能有助于降低重症加强护理病房获得性肌无力的发生率和严重程度。
