Baum P, Bercker S, Villmann T, Classen J, Hermann W
Klinik und Poliklinik für Neurologie, Universität Leipzig, Liebigstraße 20, 04103, Leipzig.
Nervenarzt. 2011 Apr;82(4):468-74. doi: 10.1007/s00115-010-3094-5.
Critical Illness Myopathy and Neuropathy (CRIMYN) frequently coexist with severe sepsis and is associated with prolonged weaning from mechanical ventilation and prolonged ICU length of stay. We aimed to classify different levels as well as patterns of impairment with regard to electrophysiological disturbances in CRIMYN patients by cluster analysis.
A total of 30 patients with sepsis/SIRS were studied prospectively. Motor and sensory conduction studies were performed from six motor and four sensory nerves on a weekly basis from admission until discharge and finally after 6 months. A control group of 63 healthy persons was examined simultaneously using the same criteria. Different patterns of electrophysiological disturbances were classified by cluster analysis based on differences to reference values of 20 parameters, compound muscle action potential (CMAP), sensory nerve action potential (SNAP) and motor and sensor conduction velocity (NCV).
Four different clusters were identified: cluster 1 showing normal values for CMAP, SNAP and NCV in all nerves (3 patients and all test persons), cluster 2 showing pathological values for CMAP in the lower extremities and the other parameters were normal (5 patients), cluster 3 showing moderately pathological values for CMAP, SNAP and sensory NCV in upper and lower extremities and motor NCV in lower extremities (12 patients) and cluster 4 showing severe disturbances of CMAP, SNAP and NCV in upper and lower extremities (10 patients).
A total of four different clusters of electrophysiological impairment can be identified in patients with sepsis/SIRS, which enables further differentiation of the severity of neuromuscular disturbances in sepsis-associated organ failure. This might be useful as a prognostic parameter and can be correlated with additional clinical and paraclinical parameters related to sepsis.
危重症性肌病和神经病（CRIMYN）常与严重脓毒症并存，且与机械通气脱机时间延长及重症监护病房（ICU）住院时间延长相关。我们旨在通过聚类分析对CRIMYN患者电生理紊乱的不同程度及模式进行分类。
前瞻性研究了30例脓毒症/全身炎症反应综合征（SIRS）患者。从入院至出院，每周一次，共进行6次，最后在6个月后，对六条运动神经和四条感觉神经进行运动和感觉传导研究。同时，按照相同标准对63名健康人组成的对照组进行检查。基于20项参数（复合肌肉动作电位（CMAP）、感觉神经动作电位（SNAP）以及运动和感觉神经传导速度（NCV））与参考值的差异，通过聚类分析对不同模式的电生理紊乱进行分类。
识别出四种不同的聚类：聚类1在所有神经中CMAP、SNAP和NCV均显示正常数值（3例患者以及所有测试对象）；聚类2在下肢CMAP显示病理数值，其他参数正常（5例患者）；聚类3在上肢和下肢CMAP、SNAP以及感觉NCV显示中度病理数值，在下肢运动NCV显示中度病理数值（12例患者）；聚类4在上肢和下肢CMAP、SNAP和NCV显示严重紊乱（10例患者）。
在脓毒症/SIRS患者中总共可识别出四种不同的电生理损伤聚类，这有助于进一步区分脓毒症相关器官衰竭中神经肌肉紊乱的严重程度。这可能作为一个预后参数有用，并且可与脓毒症相关的其他临床和辅助临床参数相关联。
