Bolton C F
University of Western Ontario, Victoria Hospital, London, Canada.
Intensive Care Med. 1993;19 Suppl 2:S58-63. doi: 10.1007/BF01708802.
Sepsis and multiple organ failure are major problems in medical and surgical intensive care units. Critical illness polyneuropathy occurs in 70% of these patients. Difficulty in weaning from the ventilator is an early sign. Electrophysiological studies are necessary to establish the diagnosis; these studies show an axonal degeneration of peripheral nerve fibres. Recovery occurs in weeks or months, depending upon severity. Muscle biopsy reveals denervation atrophy. Sepsis itself does not induce a neuromuscular transmission defect, but neuromuscular blocking agents may increase the severity of critical illness polyneuropathy. If steroids are used in addition to neuromuscular blocking agents, a severe myopathy may result. Other effects on muscle are cachectic myopathy and panfascicular muscle fibre necrosis. A variety of combinations of these conditions may affect the same patient. Only well-designed prospective studies will determine the true effect of these medications on the neuromuscular system in septic patients.
脓毒症和多器官功能衰竭是内科和外科重症监护病房的主要问题。70%的此类患者会发生危重病性多发性神经病。脱机困难是早期迹象。需进行电生理检查以明确诊断；这些检查显示周围神经纤维轴索性变性。恢复情况取决于严重程度，可能需要数周或数月。肌肉活检显示失神经萎缩。脓毒症本身不会导致神经肌肉传递缺陷，但神经肌肉阻滞剂可能会加重危重病性多发性神经病的严重程度。若在使用神经肌肉阻滞剂的基础上再使用类固醇，可能会导致严重的肌病。对肌肉的其他影响包括恶病质性肌病和束状肌纤维坏死。这些情况的多种组合可能会影响同一患者。只有精心设计的前瞻性研究才能确定这些药物对脓毒症患者神经肌肉系统的真正影响。
