Sheth R D, Bolton C F
Department of Neurology, West Virginia University Health Sciences Center, Morgantown 26506-9180, USA.
J Child Neurol. 1995 Sep;10(5):346-52. doi: 10.1177/088307389501000502.
Sepsis occurs frequently in the pediatric intensive care unit and is a significant cause of morbidity and mortality. Multiple organ systems are adversely affected by sepsis. Approximately 70% of adult patients with sepsis have peripheral nervous system dysfunction on electrophysiologic studies, of whom 30% are symptomatic. Neuromuscular dysfunction in children with sepsis is increasingly reported; however, the incidence remains undefined. Flaccid quadriplegia with the inability to wean from ventilatory support despite full cardiopulmonary recovery is the typical presentation. However, lesser degrees of weakness may be demonstrated with careful evaluation. Electrophysiologic studies often demonstrate the presence of axonal polyneuropathies, abnormalities of neuromuscular transmission, or acute myopathies. Identifiable neuromuscular syndromes in children with sepsis include critical illness polyneuropathy, pure motor polyneuropathy, thick-filament myopathy, and necrotizing myopathy. The common underlying pathogenic process in these syndromes appears to be sepsis, which may be accentuated by the administration of steroids or neuromuscular blocking agents. Recovery in strength usually occurs over a period of weeks to months.
脓毒症在儿科重症监护病房中频繁发生，是发病和死亡的重要原因。多个器官系统都会受到脓毒症的不利影响。在接受电生理研究的成年脓毒症患者中，约70%存在外周神经系统功能障碍，其中30%有症状。脓毒症患儿的神经肌肉功能障碍报道日益增多；然而，其发病率仍不明确。典型表现为尽管心肺功能已完全恢复，但仍出现弛缓性四肢瘫且无法脱离通气支持。然而，经过仔细评估可能会发现程度较轻的肌无力。电生理研究常显示存在轴索性多发性神经病、神经肌肉传递异常或急性肌病。脓毒症患儿中可识别的神经肌肉综合征包括危重病性多发性神经病、纯运动性多发性神经病、粗肌丝肌病和坏死性肌病。这些综合征常见的潜在致病过程似乎是脓毒症，使用类固醇或神经肌肉阻滞剂可能会加重病情。肌力通常在数周至数月内恢复。
