关注重症监护病房获得性肌无力

关注重症监护病房获得性肌无力 Focus on ICU-AW,盛志勇,感觉 有点不可思议。,当患者出现撤机困难时。,肺部原发疾病心功能液体负荷电解质紊乱镇静药物神经系统.,可能会忽略。,Intensive care unit acquired weakness ICU-AW ICU获得性肌无力,实际情况,全球每年有13002000万人因需生命支持入住ICU.美国每年有75万人接受机械通气，其中30万人5天以上将近25%的机械通气将发生ICU-AWICU-AW:全球 100万 美国 7.5 万,定义 Definition,ICUAW is a syndrome of generalized limb weakness that develops while the patient is critically ill and for which there is no alternative explanation other than the critical illness itself,ICU获得性肌无力是指重症患者所发生的、以肢体肌力减弱为主要表现，除了疾病本身无其他原因可以解释的一类综合征。（膈肌及肋间肌？）,Clinical features associated with ICU-AW,ICU-AW,危重病性肌病 ( critical illness myopathy ，CIM) 危重病性多发性神经病 ( critical illness polyneuropathy，CIP ) 危重病性多发性神经肌肉病 ( critical illness polyneuromyopathy ，CIPNM) CIM 和/ 或CIP 是ICU-AW的主要原因,病因,SIRS和MODS高血糖皮质激素的应用神经肌肉阻滞剂长期卧床、活动限制、延迟自主性物理运动。,SIRS/MODS引起ICU-AW,Hematoxylin and eosin (HE) staining showing inflammatory cell infiltrate into muscle incritical illness myopathy.,微血管受损缺血神经损伤肌肉细胞凋亡肌细胞丢失,病理改变,Selective thick filament loss Predominant type II muscle fibre atrophy Muscle membrane inexcitability J Cachexia Sarcopenia Muscle (2010) 1:147157,ICU住院时间与肌肉密度的关系,Experiments in healthy volunteers reveal that muscle atrophy begins within hours of immobility,14 resulting in a 45% loss of muscle strength for each week of bed rest. The interaction of critical illness with immobility may lead to even greater muscle loss,Immobility and Disuse Atrophy,约束/制动的影响,ICU-AW后果,脱机失败或脱机时间延长肢体功能障碍死亡率增高,Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national,multi-centre, prospective cohort study,诊断,诊断,MEDICAL RESEARCH COUNCIL SCALE (MRCS),ICU-AW 电生理学特征,刺激运动神经干,诱发所刺激神经支配的肌肉.在该肌肉记录运动电位,称为复合肌肉动作电位, CMAP(compound muscle action potential),刺激远端神经，在近端神经干记录动作电位，称之为感觉神经动作电位SNAP(Sensory nerve action potential),超声,How to do?,the treatment group performed a passive or active exercise training session for 20 mins/day,using a bedside ergometer.,结果,Figure 3. A, Boxplot of 6MWD at hospital discharge. 6MWD, 6-min walking distance. *p .05 compared with control group.,Isometric quadriceps force at ICU discharge and at hospital discharge.QF, quadriceps force; hospital, day of hospital discharge. *p.01 between ICU andhospital discharge; p.05 compared with control group,Conclusions :Early exercise training in critically ill intensive care unit survivors enhanced recovery of functional exercise capacity, self-perceived functional status, and muscle force at hospital discharge. 结论：早期功能锻炼可以提高ICU存活患者肌肉力量、功能锻炼恢复能力和自我感觉状态。,p = 0.048,结论：虽然电