Department of Speech-Language Pathology,University of Toronto, Ontario, Canada.
Am J Crit Care. 2012 Mar;21(2):139-8. doi: 10.4037/ajcc2012453.
Neurodegenerative diseases are often associated with life-threatening declines in respiratory and swallowing mechanisms. We report the case of a 70-year-old man who had postoperative dysphagia and respiratory failure that required reintubation after coronary artery bypass surgery. Impairment of the patient's speech, swallowing, and respiratory mechanisms identified during postoperative clinical and instrumental examinations was suggestive of a neurodegenerative disease. Genetic testing confirmed a diagnosis of spinal-bulbar muscular atrophy (Kennedy disease). This case report aims to highlight increased morbidity in patients with undiagnosed neuromuscular disorders in the critical care setting and the benefits of vigilant postoperative monitoring and multidisciplinary involvement throughout the care of complex patients.
神经退行性疾病常伴有危及生命的呼吸和吞咽机制下降。我们报告了一例 70 岁男性患者,该患者在冠状动脉旁路手术后出现吞咽困难和呼吸衰竭,需要重新插管。术后临床和仪器检查中发现的患者言语、吞咽和呼吸机制受损提示存在神经退行性疾病。基因检测证实诊断为脊髓延髓肌萎缩症(肯尼迪病)。本病例报告旨在强调在重症监护环境中,未确诊的神经肌肉疾病患者的发病率增加,以及在复杂患者的治疗过程中进行警惕的术后监测和多学科参与的重要性。