Patterns of neurophysiological abnormality in prolonged critical illness
Patterns of neurophysiological abnormality in prolonged critical illness
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DOI：
10.1007/s001340050669
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发表时间：
1998-08-01
影响因子：
38.9
通讯作者：
Hinds, CJ
中科院分区：
文献类型：
--
作者：
Coakley, JH;Nagendran, K;Hinds, CJ
目的：为了描述各种模式的神经生理异常，可能会复杂化长期的危重病，并确定可能的病因学因素，设计：前瞻性病例系列的神经生理学研究，疾病的严重程度评分，器官衰竭，药物治疗和医院的结果。一些患者还进行了肌肉活检，地点：一所大学医院的普通重症监护室（ICU）。患者：44名需要在重症监护室停留超过7天的患者。中位年龄为60（范围27-84岁），APACHE II评分19（范围8-33），器官衰竭3例（范围1-6），死亡率为23%，结果：7例患者神经生理学正常（I组），4例患者主要为感觉轴索神经病（第二组），11例患者出现运动综合征，表现为复合肌肉动作电位和感觉动作电位明显降低，在正常范围内19例合并有运动和感觉异常（IV组）。3例患者检查异常，但无法归类为上述组（V组）。所有患者的神经传导速度均正常。肌电图显示，在第三组和第四组中的五名患者的去神经支配的证据。神经电生理异常类型与APACHE Ⅱ评分、器官功能衰竭评分、脓毒症、肌松药和类固醇的使用无明显关系。在这些变化和神经生理学异常之间没有明确的关系，尽管组织学上正常的肌肉仅在具有正常神经生理学的患者中发现。只有三个从第三组中的8例患者进行肌肉活检的组织学变化与肌病相兼容，结论：神经生理异常并发危重病可以大致分为三种类型-感觉异常单独，纯运动综合征和混合运动和感觉障碍。运动综合征可以解释为运动轴突最远端部分、神经肌肉接头或运动终板的异常，在某些情况下，还可以解释为肌膜不兴奋或肌肉体积极度丧失。混合运动和感觉障碍，这是“危重病多发性神经病”的特点，可以解释为纯运动综合征和轻度感觉神经病的组合。更精确地识别各种神经生理异常和病因学因素可能会导致进一步了解危重患者神经肌肉无力的原因，并最终采取预防和治疗措施。
Objective: To describe the various patterns of neurophysiological abnormalities which may complicate prolonged critical illness and identify possible aetiological factors,Design: Prospective case series of neurophysiological studies, severity of illness scores, organ failures, drug therapy and hospital outcome. Some patients also had muscle biopsies,Setting: General intensive care unit (ICU) in a University Hospital.Patients: Forty-four patients requiring intensive care unit stay of more than 7 days. The median age was 60 (range 27-84 years), APACHE II score 19 (range 8-33), organ failures 3 (range 1-6), and mortality was 23 %,Results: Seven patients had normal neurophysiology (group I), 4 had a predominantly sensory axonal neuropathy (group II), 11 had motor syndromes characterised by markedly reduced compound muscle action potentials and sensory action potentials in the normal range (group III) and 19 had combinations of motor and sensory abnormalities (group IV). Three patients had abnormal studies but could not be classified into the above groups (group V). All patients had normal nerve conduction velocities. Electromyography revealed evidence of denervation in five patients in group III and five in group IV. There was no obvious relationship between the pattern of neurophysiological abnormality and the APACHE II score, organ failure score, the presence of sepsis or the administration of muscle relaxants and steroids, A wide range of histological abnormalities was seen in the 24 patients who had a muscle biopsy; there was no clear relationship between these changes and the neurophysiological abnormalities, although histologically normal muscle was only found in patients with normal neurophysiology. Only three of the eight patients from group III in whom muscle biopsy was performed had histological changes compatible with myopathy,Conclusions: Neurophysiological abnormalities complicating critical illness can be broadly divided into three types - sensory abnormalities alone, a pure motor syndrome and a mixed motor and sensory disturbance. The motor syndrome could be explained by an abnormality in the most distal portion of the motor axon, at the neuromuscular junction or the motor end plate and, in some cases, by inexcitable muscle membranes or extreme loss of muscle bulk. The mixed motor and sensory disturbance which is characteristic of 'critical illness polyneuropathy' could be explained by a combination of the pure motor syndrome and the mild sensory neuropathy. More precise identification of the various neurophysiological abnormalities and aetiological factors may lead to further insights into the causes of neuromuscular weakness in the critically ill and ultimately to measures for their prevention and treatment.