Constable H, Wood F, Jones K
Acute Medical Unit, Royal Bolton Hospital, Bolton.
Acute Med. 2014;13(1):36-41.
Proximal muscle weakness can present acutely or subacutely to the Acute Medical Unit. Early diagnosis of the underlying pathology is essential due to life threatening complications such as respiratory failure and cardiac disturbances as well as causing significant levels of disability. The diagnosis requires thorough history-taking and examination to discern evidence of true weakness, assess its onset, distribution and severity followed by extensive investigations including a CK level, which if high should raise suspicion of rhabdomyolysis. Assessment of respiratory function should be done promptly to identify patients with associated respiratory muscle weakness and treatment should not be delayed waiting for definitive and confirmatory investigations. Poor response to treatment is unusual when diagnosis is correct; this raises the possibility of an alternative diagnosis.
近端肌无力可急性或亚急性地出现在急性内科病房。由于存在呼吸衰竭和心脏功能紊乱等危及生命的并发症以及导致严重残疾，对潜在病理状况进行早期诊断至关重要。诊断需要全面的病史采集和体格检查，以辨别真正肌无力的证据，评估其起病、分布和严重程度，随后进行广泛的检查，包括肌酸激酶（CK）水平检测，如果该水平升高，则应怀疑横纹肌溶解症。应立即评估呼吸功能，以识别伴有呼吸肌无力的患者，治疗不应因等待确定性和确诊性检查而延迟。当诊断正确时，对治疗反应不佳并不常见；这增加了存在其他诊断的可能性。
