Wang Xiaomin, Zhu Xiaoping
Department of Respiratory, East Hospital, Tong ji University, Shanghai 200120, China. Corresponding author: Zhu Xiaoping, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2020 Aug;32(8):1020-1024. doi: 10.3760/cma.j.cn121430-20200709-00505.
In recent years, it has been gradually recognized that muscle weakness is a prominent and common problem in intensive care unit (ICU). It is estimated that more than 1 million patients worldwide develop ICU-acquired weakness (ICU-AW) each year. Its etiology is complex and the prognosis is poor. Respiratory muscle paralysis may even occur in severe cases, resulting in prolonged mechanical ventilation and hospitalization, increasing the hospital mortality of ICU patients, and leading to chronic disability. The pathogenesis of ICU-AW is not yet fully understood. Early recognition and diagnosis are difficult, and standard treatment strategies are lacking. This review focuses on the pathogenesis of muscle atrophy and muscle dysfunction, analyzes the advantages and disadvantages of current diagnostic methods for ICU-AW, and discusses the important significance of rehabilitation for the recovery of neuromuscular function in patients with ICU-AW on this basis, in order to improve clinicians' diagnosis and treatment of patients with ICU-AW, reduce mortality and improve prognosis.
近年来,人们逐渐认识到肌肉无力是重症监护病房(ICU)中一个突出且常见的问题。据估计,全球每年有超过100万患者发生重症监护病房获得性肌无力(ICU-AW)。其病因复杂,预后较差。严重情况下甚至可能发生呼吸肌麻痹,导致机械通气时间延长和住院时间延长,增加ICU患者的医院死亡率,并导致慢性残疾。ICU-AW的发病机制尚未完全明确。早期识别和诊断困难,且缺乏标准的治疗策略。本综述聚焦于肌肉萎缩和肌肉功能障碍的发病机制,分析当前ICU-AW诊断方法的优缺点,并在此基础上探讨康复对ICU-AW患者神经肌肉功能恢复的重要意义,以提高临床医生对ICU-AW患者的诊治水平,降低死亡率,改善预后。