Critical illness polyneuropathy:: risk factors and clinical consequences.: A cohort study in septic patients
Critical illness polyneuropathy:: risk factors and clinical consequences.: A cohort study in septic patients
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DOI：
10.1007/s001340101009
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发表时间：
2001-08-01
影响因子：
38.9
通讯作者：
Moyano-Del-Estad, MR
中科院分区：
文献类型：
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作者：
Garnacho-Montero, J;Madrazo-Osuna, J;Moyano-Del-Estad, MR
目的：探讨重症多发性神经病(CIP)的危险因素和临床后果，以评估其对机械通气时间、住院时间和病死率的影响。设计：初始队列研究。地点：三级医院重症监护室。患者：脓毒症患者合并多器官功能障碍综合征需要机械通气，无多神经病史。干预：患者在机械通气开始后第10天和第21天进行两次预定的电生理检查(EPS)。结果：共纳入82例患者，其中9例未纳入分析。在73例患者中，46例在第一次EPS时表现为CIP，另外4例在第二次评估时被诊断为CIP。有无CIP的患者入院时和首次EPS当天的APACHE II评分相似。然而。机械通气天数[32·3(21·1)天比18·5(5·8)天；P=0.002]、ICU天数、ICU存活出院患者住院天数和住院死亡率较高(42/50，84%比13/23，56·5%；P=0·01)。经多因素分析，高渗[OR4.8；95%可信区间(95%CI1.05~24.38：P=0.046)]、肠外营养(OR5.11；95%CI1.14~22.88；p=0.046)、神经肌肉阻滞剂的使用(OR16.32；95%CI1.34~199；p=0.0008)和神经功能衰竭(GCS<10分)(OR24.02；95%CI3.68~156.7；p<；0.001)是独立的危险因素。而接受肾脏替代治疗的患者发生脑缺血的风险较低(OR0.02；95%CI0.05-0.15；p<；0.001)。多因素分析显示，CIP(OR7.11；95%CI1.54~32.75；P<；0.007)、年龄>60岁(OR9.07；95%CI2.02~40.68；P<；0.002)、肾功能最差(OR2.18；95%CI1.27~3.74；P<；0.002)是住院死亡的独立预测因素。高渗透压，肠外营养。非去极化神经肌肉阻滞剂和神经功能衰竭有助于CIP的发展。
Objective: To determine risk factors and clinical consequences of critical illness polyneuropathy (CIP) evaluated by the impact on duration of mechanical ventilation, length of stay and mortality.Design: Inception cohort study.Setting: Intensive care unit of a tertiary hospital.Patients: Septic patients with multiple organ dysfunction syndrome requiring mechanical ventilation and without previous history of polyneuropathyInterventions: Patients under-went two scheduled electrophysiologic studies (EPS): on the 10th and 21st days after the onset of mechanical ventilation.Results: Eighty-two patients were enrolled, although nine of them were not analyzed. Forty-six of the 73 patients presented CIP on the first EPS and 4 other subjects were diagnosed with CIP on the second evaluation. The APACHE II scores of patients with and without CIP were similar on admission and on the day of the first EPS. However. days of mechanical ventilation [32.3 (21.1) versus 18.5 (5.8); p = 0.002], length of ICU and hospital stay in patients discharged alive from the ICU as well as in-hospital mortality were greater in patients with CIP (42/50, 84 % versus 13/23, 56.5 %; p = 0.01). After multivariate analysis, independent risk factors were hyperosmolality [odds ratio (OR) 4.8; 95 % confidence intervals (95 % CI) 1.05-24.38: p = 0.046], parenteral nutrition (OR 5.11; 95 % CI 1.14-22.88; p = 0.02), use of neuromuscular blocking agents (OR 16.32; 95 % Cl 1.34-199; p = 0.0008) and neurologic failure (GCS below 10) (OR 24.02; 95 % Cl 3.68-156.7; p < 0.001). while patients with renal replacement therapy had a lower risk for CIP development (OR 0.02; 95 % CI 0.05-0.15; p < 0.001). By multivariate analysis, CIP (OR 7.11; 95 % CI 1.54-32.75; p < 0.007), age over 60 years (OR 9.07; 95 % CI 2.02-40.68; p < 0.002) and the worst renal SOFA (OR 2.18; 95 % CI 1.27-3.74; p < 0.002) were independent predictors of in-hospital mortality.Conclusions: CIP is associated with increased duration of mechanical ventilation and in-hospital mortality. Hyperosmolality, parenteral nutrition. non-depolarizing neuromuscular blockers and neurologic failure can favor CIP development.