Harnisch Lars-Olav, Riech Sebastian, Mueller Marion, Gramueller Vanessa, Quintel Michael, Moerer Onnen
Department of Anesthesiology, University Medical Center Goettingen, 37075 Goettingen, Germany.
Interdisciplinary Department of Emergency Medicine, University Medical Center Goettingen, 37075 Goettingen, Germany.
J Clin Med. 2019 Jul 12;8(7):1020. doi: 10.3390/jcm8071020.
Neurologic complications following acute respiratory distress syndrome (ARDS) are well described, however, information on the neurologic outcome regarding peripheral nervous system complications in critically ill ARDS patients, especially those who received extracorporeal membrane oxygenation (ECMO) are lacking. In this prospective observational study 28 ARDS patients who survived after ECMO or conventional nonECMO treatment were examined for neurological findings. Nine patients had findings related to cranial nerve innervation, which differed between ECMO and nonECMO patients ( = 0.031). ECMO patients had severely increased patella tendon reflex (PTR) reflex levels ( = 0.027 vs. = 0.125) as well as gastrocnemius tendon reflex (GTR) ( = 0.041 right, = 0.149 left) were affected on the right, but not on the left side presumably associated with ECMO cannulation. Paresis (14.3% of patients) was only found in the ECMO group ( = 0.067). Paresthesia was frequent (nonECMO 53.8%, ECMO 62.5%; = 0.064), in nonECMO most frequently due to initial trauma and polyneuropathy, in the ECMO group mainly due to impairments of N. cutaneus femoris lateralis (4 vs. 0; = 0.031). Besides well-known central neurologic complications, more subtle complications were detected by thorough clinical examination. These findings are sufficient to hamper activities of daily living and impair quality of life and psychological health and are presumably directly related to ECMO therapy.
急性呼吸窘迫综合征（ARDS）后的神经系统并发症已有充分描述，然而，关于重症ARDS患者，尤其是接受体外膜肺氧合（ECMO）治疗的患者外周神经系统并发症的神经学转归信息却很缺乏。在这项前瞻性观察研究中，对28例经ECMO或传统非ECMO治疗后存活的ARDS患者进行了神经学检查。9例患者有与颅神经支配相关的表现，ECMO患者和非ECMO患者之间存在差异（P = 0.031）。ECMO患者的髌腱反射（PTR）水平显著升高（右侧P = 0.027，左侧P = 0.125），腓肠肌腱反射（GTR）右侧受影响（P = 0.041），左侧未受影响（P = 0.149），推测与ECMO插管有关。仅在ECMO组发现了轻瘫（占患者的14.3%，P = 0.067）。感觉异常很常见（非ECMO组为53.8%，ECMO组为62.5%；P = 0.064），在非ECMO组中最常见的原因是初始创伤和多发性神经病，在ECMO组中主要是由于股外侧皮神经损伤（4例对0例；P = 0.031）。除了众所周知的中枢神经系统并发症外，通过全面的临床检查还发现了更细微的并发症。这些发现足以妨碍日常生活活动，损害生活质量和心理健康，并且可能与ECMO治疗直接相关。
