Maher J, Rutledge F, Remtulla H, Parkes A, Bernardi L, Bolton C F
Department of Clinical Neurological Sciences, University of Western Ontario, Victoria Hospital, London, Canada.
Intensive Care Med. 1995 Sep;21(9):737-43. doi: 10.1007/BF01704741.
To determine, by retrospective chart analysis, the frequency, type and significance of neuromuscular disorders in patients whose clinical features suggested a neuromuscular cause of failure to wean.
Failure to wean is a common and difficult problem in critical care units. While a neuromuscular cause may be suspected in some patients, the frequency and type has not been determined utilizing comprehensive electrophysiological studies of limbs and the respiratory system. Such knowledge may aid in patient management and prognosis.
The clinical setting was a critical care/trauma centre that admits 1500 patients per year, approximately 500 being on ventilators for longer than five days. We analyzed the hospital charts of 40 patients admitted to the unit during three years, whose respiratory assessment suggested a neuromuscular cause for failure to wean from the ventilator. To investigate this possibility, we performed electrophysiological studies of the limbs and also of the respiratory system by phrenic nerve conduction and needle electromyography of the chest wall and diaphragm. The results were compared to 25 healthy controls.
38 of 40 patients (95%) had a neuromuscular disorder: 25--critical illness polyneuropathy, 2--Guillain-Barré syndrome, 4--diabetic and critical illness polyneuropathy, 2--uremic and critical illness polyneuropathy, 10--an abnormality of central drive, 5--unilateral phrenic nerve palsy, 3--a neuromuscular transmission defect, and 5--a primary myopathy. Fifteen (38%) had a combination of disorders. Patients with more severe polyneuropathy took longer to wean, a mean of 136 versus 52 days (p = 0.007). The severity of the polyneuropathy had no effect on mortality.
Electrophysiological studies of limbs and the respiratory system are together valuable in confirming the presence, and identifying the specific type of neuromuscular cause for difficulty in weaning from the ventilator. This information is important in patient management and prognosis.
通过回顾性病历分析，确定临床特征提示存在导致脱机失败的神经肌肉病因的患者中神经肌肉疾病的发生率、类型及意义。
脱机失败是重症监护病房中常见且棘手的问题。虽然部分患者可能怀疑存在神经肌肉病因，但尚未通过对肢体和呼吸系统进行全面的电生理研究来确定其发生率和类型。此类知识可能有助于患者管理及预后判断。
研究背景为一家每年收治1500例患者的重症监护/创伤中心，其中约500例患者使用呼吸机超过5天。我们分析了该科室3年内收治的40例患者的医院病历，这些患者的呼吸评估提示存在导致无法从呼吸机脱机的神经肌肉病因。为探究这种可能性，我们对肢体以及通过膈神经传导和胸壁及膈肌针极肌电图对呼吸系统进行了电生理研究。将结果与25名健康对照者进行比较。
40例患者中有38例（95%）存在神经肌肉疾病：25例为重症疾病性多发性神经病，2例为吉兰 - 巴雷综合征，4例为糖尿病性和重症疾病性多发性神经病，2例为尿毒症性和重症疾病性多发性神经病，10例为中枢驱动异常，5例为单侧膈神经麻痹，3例为神经肌肉传递缺陷，5例为原发性肌病。15例（38%）患者存在多种疾病组合。患有更严重多发性神经病的患者脱机时间更长，平均为136天，而其他患者为52天（p = 0.007）。多发性神经病的严重程度对死亡率无影响。
对肢体和呼吸系统进行电生理研究对于确认呼吸机脱机困难的神经肌肉病因的存在及确定其具体类型具有重要价值。该信息对患者管理及预后判断很重要。
