Senger D, Erbguth F
Universitätsklinik für Neurologie der Paracelsus Medizinischen Privatuniversität, Klinikum Nürnberg, Breslauer Str. 201, 90471, Nürnberg, Deutschland.
Med Klin Intensivmed Notfmed. 2017 Oct;112(7):589-596. doi: 10.1007/s00063-017-0339-0. Epub 2017 Sep 5.
An average of 50-80% of patients treated in the intensive care unit is affected by disturbances of neuromuscular functions due to damage to the nerves and muscles, which has led to the terms critical illness polyneuropathy and myopathy. Both components occur in 30-50% of patients, while the others predominantly show a pure myopathy, while pure neuropathy is rare. Meanwhile, the descriptive term of the concept as intensive care unit-acquired weakness (ICUAW) is preferred. The most significant risk factors for the development of ICUAW are sepsis, multiorgan dysfunction and acute respiratory distress syndrome (ARDS). In at least one third of patients, persistent impairment by paralysis, sensory disturbances and balance problems persist when they leave the ICU. At approximately 10%, these leg-accentuated and highly everyday relevant disorders persist over the first year after ICU therapy. Pure myopathy rarely leads to residual disturbances, while the neuropathic component is responsible for long-term impairments.
在重症监护病房接受治疗的患者中,平均有50%至80%会因神经和肌肉损伤而出现神经肌肉功能障碍,这导致了“重症疾病多发性神经病”和“肌病”这两个术语的出现。两种情况同时出现的患者占30%至50%,其他患者主要表现为单纯性肌病,而单纯性神经病则较为罕见。同时,“重症监护病房获得性肌无力”(ICUAW)这一概念的描述性术语更受青睐。ICUAW发生的最重要风险因素是败血症、多器官功能障碍和急性呼吸窘迫综合征(ARDS)。至少三分之一的患者在离开重症监护病房时,会持续存在瘫痪、感觉障碍和平衡问题。约10%的患者在重症监护病房治疗后的第一年,这些以腿部为主且与日常生活高度相关的疾病仍会持续存在。单纯性肌病很少导致残留障碍,而神经病变部分则是长期损伤的原因。