Gurtubay I G, Morales G, Navajas D, Carrera B, Iragui M
Servicio de Neurofisiologia Clínica, Hospital Virgen del Camino, Pamplona, España.
Rev Neurol. 1998 Jan;26(149):53-7.
Critically ill patients admitted to the Intensive Care Unit (ICU) often develop neuromuscular disorders. The objective of this study was to diagnose these and determine the causes.
We present a series of 13 critically ill patients who developed weakness or paresia, reduced or absent ROT and normal brain stem reflexes, in whom ENG and EMG studies were done in EESS and II which were considered together with data from general laboratory analysis, radiological and microbiological examinations, medication given and posterior clinical course of the patient. Muscle biopsy was not done in any patient.
All the patients were intubated, with signs of sepsis, multiple-organ failure and malnutrition. All had received cortico-steroids and amino-glucosides and 8/13 neuromuscular blockers. Neurophysiological study showed that in all cases there was axon type neuropathy, mainly motor and in the lower limbs. Fifty four percent of the patients died. The neuropathy improved in the others.
Critically ill patients often have axon type neuropathy. In our series, the causes of this were sepsis and multiple organ failure. It is important that this pathology be ruled out in the critically ill patient whom it is difficult to disintubate and/or has generalized muscle weakness.
入住重症监护病房（ICU）的重症患者常发生神经肌肉疾病。本研究的目的是诊断这些疾病并确定其病因。
我们报告了13例重症患者，这些患者出现了肌无力或轻瘫、旋转试验（ROT）减弱或消失且脑干反射正常，在这些患者中，在EESS和II进行了肌电图（ENG）和神经电图（EMG）检查，并结合常规实验室分析、放射学和微生物学检查数据、所用药物以及患者的后续临床病程进行综合考虑。所有患者均未进行肌肉活检。
所有患者均已插管，有败血症、多器官功能衰竭和营养不良的体征。所有患者均接受了皮质类固醇和氨基糖苷类药物治疗，13例中有8例使用了神经肌肉阻滞剂。神经生理学研究表明，所有病例均存在轴索性神经病，主要为运动性且累及下肢。54%的患者死亡。其他患者的神经病有所改善。
重症患者常出现轴索性神经病。在我们的病例系列中，其病因是败血症和多器官功能衰竭。对于难以脱机和/或出现全身性肌无力的重症患者，排除这种病理情况很重要。
