Latronico N, Fenzi F, Recupero D, Guarneri B, Tomelleri G, Tonin P, De Maria G, Antonini L, Rizzuto N, Candiani A
Instituto di Anestesia-Rianimazione, Spedali Civili, Università di Brescia, Italy.
Lancet. 1996 Jun 8;347(9015):1579-82. doi: 10.1016/s0140-6736(96)91074-0.
Critically ill patients may develop muscle weakness or paralysis during the course of sepsis and multiple-organ failure. We studied peripheral nerve and muscle disorders (NMD) in comatose patients.
Comatose patients who developed paralysis associated with absent deep-tendon reflexes had electroneuromyography (ENMG) and muscle-nerve biopsy specimens taken. Onset and duration of sepsis, multiple-organ dysfunction and failure, biochemical alterations, and drugs potentially interfering with nerve-muscle function were recorded.
24 patients became quadriparetic or quadriplegic; muscle changes were found in 23. Axonal neuropathy was found in eight of 22 patients examined. All patients had prolonged sepsis and multiple-organ dysfunction, but only 14 had multiple-organ failure. Drugs such as steroids, neuromuscular-blocking agents, and aminoglycosides were not responsible for paresis, and the part played by hyperglycaemia and hypoalbuminaemia is uncertain. Attending physicians predicted a fatal outcome in all cases, although six of seven survivors fully recovered within 115-210 days from the onset of paralysis.
Comatose patients may become completely paralysed because of NMD. The diagnosis is important to avoid unnecessary investigations and unreasonably pessimistic prognosis. ENMG is essential for the diagnosis and for planning further clinical management. Biopsy needs to be done only when it is necessary to properly classify NMD.
重症患者在脓毒症和多器官功能衰竭过程中可能会出现肌肉无力或麻痹。我们研究了昏迷患者的周围神经和肌肉疾病（NMD）。
对出现与腱反射消失相关的麻痹的昏迷患者进行了肌电图（ENMG）检查，并采集了肌肉-神经活检标本。记录脓毒症的发病时间和持续时间、多器官功能障碍和衰竭、生化改变以及可能干扰神经肌肉功能的药物。
24例患者出现四肢瘫软或四肢麻痹；23例发现肌肉改变。在接受检查的22例患者中，8例发现轴索性神经病。所有患者均有脓毒症持续时间延长和多器官功能障碍，但只有14例出现多器官衰竭。类固醇、神经肌肉阻滞剂和氨基糖苷类等药物并非导致轻瘫的原因，高血糖和低白蛋白血症所起的作用尚不确定。主治医生预计所有病例的预后均为致命，但7名幸存者中有6名在麻痹发作后的115 - 210天内完全康复。
昏迷患者可能因NMD而完全瘫痪。该诊断对于避免不必要的检查和不合理的悲观预后很重要。ENMG对于诊断和规划进一步的临床管理至关重要。仅在需要对NMD进行正确分类时才需要进行活检。
