Bolton C F, Laverty D A, Brown J D, Witt N J, Hahn A F, Sibbald W J
J Neurol Neurosurg Psychiatry. 1986 May;49(5):563-73. doi: 10.1136/jnnp.49.5.563.
A polyneuropathy of varying severity has been observed in association with sepsis and critical illness in 15 patients. Since clinical evaluation is often difficult, electrophysiological studies provided definitive evidence for polyneuropathy. These revealed reductions in the amplitudes of compound muscle and sensory nerve action potentials, the most marked abnormality. Near-nerve recordings confirmed such reductions for sensory fibres. Needle electromyography revealed signs of denervation of limb muscles. Phrenic nerve conduction and needle electromyographic studies of chest wall muscles suggested that the polyneuropathy partially explained difficulties in weaning patients from the ventilator, an early clinical sign. No defect in neuromuscular transmission was demonstrated, despite the use of aminoglycoside antibiotics in some patients. In those who survived the critical illness, clinical and electrophysiological improvement occurred. The 15 critically ill polyneuropathy patients were compared with 16 Guillain-Barré syndrome patients observed during the same period. The analysis showed that the two polyneuropathies are likely to be separate entities that can be distinguished in most instances by the predisposing illness, electrophysiological features and cerebrospinal fluid results.
在15例患者中，观察到与脓毒症和危重病相关的不同严重程度的多发性神经病。由于临床评估往往困难，电生理研究为多发性神经病提供了确凿证据。这些研究显示复合肌肉动作电位和感觉神经动作电位的幅度降低，这是最明显的异常。神经附近记录证实了感觉纤维的这种降低。针极肌电图显示肢体肌肉失神经支配的迹象。膈神经传导和胸壁肌肉的针极肌电图研究表明，多发性神经病部分解释了患者脱机困难这一早期临床征象。尽管一些患者使用了氨基糖苷类抗生素，但未发现神经肌肉传递缺陷。在危重病中存活的患者，临床和电生理状况有所改善。将15例危重病性多发性神经病患者与同期观察的16例吉兰-巴雷综合征患者进行比较。分析表明，这两种多发性神经病可能是不同的实体，在大多数情况下可以通过诱发疾病、电生理特征和脑脊液结果加以区分。
