关注重症监护病房获得性肌无力ppt课件

关注重症监护病房获得性肌无力,1,关注重症监护病房获得性肌无力FocusonICU-AW,关注重症监护病房获得性肌无力,2,感觉有点不可思议。,关注重症监护病房获得性肌无力,3,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.,关注重症监护病房获得性肌无力,4,可能会忽略。,IntensivecareunitacquiredweaknessICU-AWICU获得性肌无力,关注重症监护病房获得性肌无力,5,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,关注重症监护病房获得性肌无力,6,定义Definition,ICUAWisasyndromeofgeneralizedlimbweaknessthatdevelopswhilethepatientiscriticallyillandforwhichthereisnoalternativeexplanationotherthanthecriticalillnessitself,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？）,关注重症监护病房获得性肌无力,7,ClinicalfeaturesassociatedwithICU-AW,关注重症监护病房获得性肌无力,8,ICU-AW,危重病性肌病(criticalillnessmyopathy，CIM)危重病性多发性神经病(criticalillnesspolyneuropathy，CIP)危重病性多发性神经肌肉病(criticalillnesspolyneuromyopathy，CIPNM)CIM和/或CIP是ICU-AW的主要原因,关注重症监护病房获得性肌无力,9,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。,关注重症监护病房获得性肌无力,10,关注重症监护病房获得性肌无力,11,SIRS/MODS引起ICU-AW,Hematoxylinandeosin(HE)stainingshowinginflammatorycellinfiltrateintomuscleincriticalillnessmyopathy.,微血管受损缺血神经损伤肌肉细胞凋亡肌细胞丢失,关注重症监护病房获得性肌无力,12,病理改变,SelectivethickfilamentlossPredominanttypeIImusclefibreatrophyMusclemembraneinexcitabilityJCachexiaSarcopeniaMuscle(2010)1:147157,关注重症监护病房获得性肌无力,13,关注重症监护病房获得性肌无力,14,关注重症监护病房获得性肌无力,15,ICU住院时间与肌肉密度的关系,Experimentsinhealthyvolunteersrevealthatmuscleatrophybeginswithinhoursofimmobility,14resultingina45%lossofmusclestrengthforeachweekofbedrest.Theinteractionofcriticalillnesswithimmobilitymayleadtoevengreatermuscleloss,ImmobilityandDisuseAtrophy,约束/制动的影响,关注重症监护病房获得性肌无力,16,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,关注重症监护病房获得性肌无力,17,EarlymobilizationandrecoveryinmechanicallyventilatedpatientsintheICU:abi-national,multi-centre,prospectivecohortstudy,关注重症监护病房获得性肌无力,18,诊断,关注重症监护病房获得性肌无力,19,诊断,关注重症监护病房获得性肌无力,20,MEDICALRESEARCHCOUNCILSCALE(MRCS),关注重症监护病房获得性肌无力,21,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(compoundmuscleactionpotential),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(Sensorynerveactionpotential),关注重症监护病房获得性肌无力,22,超声,关注重症监护病房获得性肌无力,23,关注重症监护病房获得性肌无力,24,关注重症监护病房获得性肌无力,25,Howtodo?,关注重症监护病房获得性肌无力,26,关注重症监护病房获得性肌无力,27,thetreatmentgroupperformedapassiveoractiveexercisetrainingsessionfor20mins/day,usingabedsideergometer.,关注重症监护病房获得性肌无力,28,结果,Figure3.A,Boxplotof6MWDathospitaldischarge.6MWD,6-minwalkingdistance.*p.05comparedwithcontrolgroup.,IsometricquadricepsforceatICUdischargeandathospitaldischarge.QF,quadricepsforce;hospital,dayofhospitaldischarge.*p.01betweenICUandhospitaldischarge;p.05comparedwithcontrolgroup,关注重症监护病房获得性肌无力,29,Conclusions:Earlyexercisetrainingincriticallyillintensivecareunitsurvivorsenhancedrecoveryoffunctionalexercisecapacity,self-perceivedfunctionalstatus,andmuscleforceathospitaldischarge.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。,关注重症监护病房获得性肌无力,30,关注重症监护病房获得性肌无力,31,关注重症监护病房获得性肌无力,32,关注重症监护病房获得性肌无力,33,p=0.048,关注重症监护病房获得性肌无力,34,结论：虽然电刺激不能防止ICU-AW的发生，但可以减轻肌无力程度，帮助脱机。,关注重症监护病房获得性肌无力,35,