新型冠状病毒肺炎危重症患者的神经肌肉受累。
Neuromuscular involvement in COVID-19 critically ill patients.
机构信息
Clinical Neurophysiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Clinical Neurophysiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.
出版信息
Clin Neurophysiol. 2020 Dec;131(12):2809-2816. doi: 10.1016/j.clinph.2020.09.017. Epub 2020 Oct 15.
OBJECTIVE
Coronavirus disease 2019 (COVID-19) has a high incidence of intensive care admittance due to the severe acute respiratory syndrome (SARS). Intensive care unit (ICU)-acquired weakness (ICUAW) is a common complication of ICU patients consisting of symmetric and generalised weakness. The aim of this study was to determine the presence of myopathy, neuropathy or both in ICU patients affected by COVID-19 and whether ICUAW associated with COVID-19 differs from other aetiologies.
METHODS
Twelve SARS CoV-2 positive patients referred with the suspicion of critical illness myopathy (CIM) or polyneuropathy (CIP) were included between March and May 2020. Nerve conduction and concentric needle electromyography were performed in all patients while admitted to the hospital. Muscle biopsies were obtained in three patients.
RESULTS
Four patients presented signs of a sensory-motor axonal polyneuropathy and seven patients showed signs of myopathy. One muscle biopsy showed scattered necrotic and regenerative fibres without inflammatory signs. The other two biopsies showed non-specific myopathic findings.
CONCLUSIONS
We have not found any distinctive features in the studies of the ICU patients affected by SARS-CoV-2 infection.
SIGNIFICANCE
Further studies are needed to determine whether COVID-19-related CIM/CIP has different features from other aetiologies. Neurophysiological studies are essential in the diagnosis of these patients.
目的
由于严重急性呼吸系统综合征(SARS),2019 年冠状病毒病(COVID-19)的重症监护入院率很高。重症监护病房(ICU)获得性肌无力(ICUAW)是 ICU 患者的常见并发症,表现为对称和全身性无力。本研究旨在确定 COVID-19 感染的 ICU 患者是否存在肌病、神经病或两者兼有,以及与 COVID-19 相关的 ICUAW 是否与其他病因不同。
方法
2020 年 3 月至 5 月间,共纳入 12 例怀疑患有危重病性肌病(CIM)或多发性神经病(CIP)的 SARS-CoV-2 阳性患者。所有患者在住院期间均进行神经传导和同心针肌电图检查。对 3 例患者进行了肌肉活检。
结果
4 例患者表现出感觉运动轴突多神经病的迹象,7 例患者表现出肌病的迹象。1 例肌肉活检显示散在的坏死和再生纤维,无炎症迹象。另外 2 个活检显示非特异性肌病发现。
结论
我们在对 SARS-CoV-2 感染的 ICU 患者的研究中没有发现任何特征。
意义
需要进一步研究以确定 COVID-19 相关的 CIM/CIP 是否与其他病因具有不同的特征。神经生理学研究对这些患者的诊断至关重要。