Zochodne D W, Ramsay D A, Saly V, Shelley S, Moffatt S
Department of Clinical Neurosciences, University of Calgary, Alberta, Canada.
Muscle Nerve. 1994 Mar;17(3):285-92. doi: 10.1002/mus.880170305.
A series of recent reports have identified cases of a quadriplegic myopathy characterized by myofiber necrosis and loss of myosin filaments associated with the use of nondepolarizing muscle blocking agents and glucocorticoids. We report electrophysiological findings in 7 intensive care unit patients who developed evidence of an acute myopathy in association with the use of nondepolarizing muscle blocking agents. Several important features were identified: (i) a neuromuscular transmission deficit was observed in 3 patients up to 7 days following withdrawal of vecuronium; (ii) motor M potentials were of low amplitude, there was mild abnormal spontaneous activity on needle electromyography, and sensory conduction was relatively preserved; (iii) not all patients received glucocorticoids or were asthmatic; (iv) 2 patients given vecuronium had very high creatine kinase levels and developed acute renal failure associated with myoglobinuria; and (v) rises in motor M potentials accompanied clinical recovery. This complication of intensive care may be severe, but is reversible and possibly avoidable. Our findings implicate nondepolarizing muscle blocking agents in the development of the myopathy. Electrophysiological studies provide important prognostic guidance.
最近的一系列报告已确认了一些四肢瘫性肌病病例，其特征为肌纤维坏死以及与使用非去极化肌松剂和糖皮质激素相关的肌球蛋白丝丢失。我们报告了7例重症监护病房患者的电生理检查结果，这些患者在使用非去极化肌松剂后出现了急性肌病的证据。发现了几个重要特征：（i）在停用维库溴铵后长达7天的时间里，3例患者观察到神经肌肉传递缺陷；（ii）运动M波幅较低，针极肌电图显示有轻度异常自发电活动，感觉传导相对保留；（iii）并非所有患者都接受了糖皮质激素治疗或患有哮喘；（iv）2例使用维库溴铵的患者肌酸激酶水平非常高，并出现了与肌红蛋白尿相关的急性肾衰竭；（v）运动M波幅升高伴随临床恢复。这种重症监护并发症可能很严重，但具有可逆性且可能可避免。我们的发现表明非去极化肌松剂与肌病的发生有关。电生理研究提供了重要的预后指导。
