切换至 "中华医学电子期刊资源库"

中华神经创伤外科电子杂志 ›› 2018, Vol. 04 ›› Issue (03) : 175 -178. doi: 10.3877/cma.j.issn.2095-9141.2018.03.011

所属专题: 文献

综述

ICU获得性肌无力的研究进展
宛荣豪1, 陈一凡1, 李磊1, 高亮1,()   
  1. 1. 200072 上海,同济大学附属第十人民医院神经外科
  • 收稿日期:2018-02-09 出版日期:2018-06-15
  • 通信作者: 高亮

Recent advance in intensive care unit-acquired muscle weakness

Ronghao Wan1, Yifan Chen1, Lei Li1, Liang Gao1,()   

  1. 1. Department of Neurosurgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
  • Received:2018-02-09 Published:2018-06-15
  • Corresponding author: Liang Gao
  • About author:
    Corresponding author: Gao Liang, Email:
引用本文:

宛荣豪, 陈一凡, 李磊, 高亮. ICU获得性肌无力的研究进展[J]. 中华神经创伤外科电子杂志, 2018, 04(03): 175-178.

Ronghao Wan, Yifan Chen, Lei Li, Liang Gao. Recent advance in intensive care unit-acquired muscle weakness[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2018, 04(03): 175-178.

很多急危重症或经历复杂手术的患者往往需要入住重症监护病房(ICU)治疗,以期平稳度过危险期。其中,部分患者因多种原因而出现不同程度的肢体无力、呼吸肌力量减弱、深反射减弱等症状,对此现象国外学者提出了ICU获得性肌无力(IUCAW)的概念。据报道ICUAW诊断困难、恢复缓慢是导致患者撤机困难、住院时间延长的主要原因之一,对急危重症患者的预后产生了巨大的影响,从社会经济学角度而言也造成了医疗资源的过度消耗。随着电生理学及各种诊断方法的进展,在ICUAW的发病机制及治疗措施等方面均取得了长足的进步。本文将围绕ICUAW的定义及分类、基本特征、病理生理机制、诊断及防治进行概述。

Many critically ill patients or those who experienced complicated operations often need to be treated in the intensive care unit (ICU) to get through the dangerous period. Among them, some patients have diferent degrees of limb weakness, weakness of respiratory muscle strength, diminished deep tendon reflex and other symptoms for a variety of reasons, and the concept of ICU-acquired weakness (ICUAW) has been proposed for this phenomenon by some researchers. It is reported that the difficulty in diagnosis of ICUAW and its slowly recovery are main reasons leading to the difficulty of weaning and prolonged hospitalization, which have a great impact on the positive prognosis of critically ill patients. What’s more, it also causes the excessive consumption of medical resources from the perspective of social economics. With the progress of electrophysiology and various diagnostic methods, considerable progress has been made in the pathogenesis and treatment of ICUAW. This article will make an overview focusing on the definition and classification, basic features, pathophysiological mechanisms, diagnosis and prevention of ICUAW.

[1]
Ali NA,O'Brien JM Jr,Hoffmann SP, et al. Acquired weakness, handgrip strength, and mortality in critically ill patients[J]. Am J Respir Crit Care Med, 2008, 178(3): 261-268.
[2]
Sharshar T,Bastuji-Garin S,Stevens RD, et al. Presence and severity of intensive care unit-acquired paresis at time of awakening are associated with increased intensive care unit and hospital mortality[J]. Crit Care Med, 2009, 37(12): 3047-3053.
[3]
De Jonghe B,Sharshar T,Lefaucheur JP, et al. Paresis acquired in the intensive care unit: a prospective multicenter study[J]. JAMA, 2002. 288(22): 2859-2867.
[4]
Mirzakhani H,Williams JN,Mello J, et al. Muscle weakness predicts pharyngeal dysfunction and symptomatic aspiration in long-term ventilated patients[J]. Anesthesiology, 2013, 119: 389-397.
[5]
Nanas S,Kritikos K,Angelopoulos E, et al. Predisposing factors for critical illness polyneuromyopathy in a multidisciplinary intensive care unit[J]. Acta Neurol Scand, 2008, 118(3): 175-181.
[6]
Hermans G,Van Mechelen H,Clerckx B, et al. Acute outcomes and 1-year mortality of intensive care unit-acquired weakness. A cohort study and propensity-matched analysis[J]. Am J Respir Crit Care Med, 2014, 190(4): 410-420.
[7]
Tzanis G,Vasileiadis I,Zervakis D, et al. Maximum inspiratory pressure, a surrogate parameter for the assessment of ICU-acquired weakness[J]. BMC Anesthesiol, 2011, 11: 14.
[8]
Fan E,Cheek F,Chlan L, et al. An official American Thoracic Society Clinical Practice guideline: the diagnosis of intensive care unit-acquired weakness in adults[J]. Am J Respir Crit Care Med, 2014, 190(12): 1437-1446.
[9]
Stevens RD,Marshall SA,Cornblath DR, et al. A framework for diagnosing and classifying intensive care unit-acquired weakness[J]. Crit Care Med, 2009, 37(10 Suppl): S299-308.
[10]
Kress JP,Hall JB. ICU-acquired weakness and recovery from critical illness[J]. N Engl J Med, 2014, 371(3): 287-288.
[11]
NICE-SUGAR Study Investigators, Finfer S,Liu B, et al. Hypoglycemia and risk of death in critically ill patients[J]. N Engl J Med, 2012, 367(12): 1108-1118.
[12]
Latronico N,Fenzi F,Recupero D, et al. Critical illness myopathy and neuropathy[J]. Lancet, 1996, 347(9015): 1579-1582.
[13]
Hermans G,Van den Berghe G. Clinical review: intensive care unit acquired weakness[J]. Crit Care, 2015, 19: 274.
[14]
Van den Berghe G,Schoonheydt K,Becx P, et al. Insulin therapy protects the central and peripheral nervous system of intensive care patients[J]. Neurology, 2005, 64(8): 1348-1353.
[15]
Bolton CF. Neuromuscular manifestations of critical illness[J]. Muscle Nerve, 2005, 32(2): 140-163.
[16]
Rich MM,Pinter MJ. Crucial role of sodium channel fast inactivation in muscle fibre inexcitability in a rat model of critical illness myopathy[J]. J Physiol, 2003, 547(Pt 2): 555-566.
[17]
Garnacho-Montero J,Madrazo-Osuna J,García-Garmendia JL, et al. Critical illness polyneuropathy: risk factors and clinical consequences: a cohort study in septic patients[J]. Intensive Care Med, 2001, 27(8): 1288-1296.
[18]
Carre JE,Orban JC,Re L, et al. Survival in critical illness is associated with early activation of mitochondrial biogenesis[J]. Am J Respir Crit Care Med, 2010, 182(6): 745-751.
[19]
Reid MB,Moylan JS. Beyond atrophy: redox mechanisms of muscle dysfunction in chronic inflammatory disease[J]. J Physiol, 2011, 589(Pt 9): 2171-2179.
[20]
Powers SK,Shanely RA,Coombes JS, et al. Mechanical ventilation results in progressive contractile dysfunction in the diaphragm[J]. J Appl Physiol (1985), 2002, 92(5): 1851-1858.
[21]
Levine S,Nguyen T,Taylor N, et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans[J]. N Engl J Med, 2008, 358(13): 1327-1335.
[22]
Jaber S,Petrof BJ,Jung B, et al. Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans[J]. Am J Respir Crit Care Med, 2011, 183(3): 364-371.
[23]
Levine S,Biswas C,Dierov J, et al. Increased proteolysis, myosin depletion, and atrophic AKT-FOXO signaling in human diaphragm disuse[J]. Am J Respir Crit Care Med, 2011, 183(4): 483-490.
[24]
Griffiths RD,Palmer TE,Helliwell T, et al. Effect of passive stretching on the wasting of muscle in the critically ill[J]. Nutrition, 1995, 11(5): 428-432.
[25]
Hermans G,Clerckx B,Vanhullebusch T, et al. Interobserver agreement of Medical Research Council sum-score and handgrip strength in the intensive care unit[J]. Muscle Nerve, 2012, 45(1): 18-25.
[26]
Latronico N,Bolton CF. Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis[J]. Lancet Neurol, 2011, 10(10): 931-941.
[27]
Weber-Carstens S,Koch S,Spuler S, et al. Nonexcitable muscle membrane predicts intensive care unit-acquired paresis in mechanically ventilated, sedated patients[J]. Crit Care Med, 2009, 37(9): 2632-2637.
[28]
Wieske L,Witteveen E,Petzold A, et al. Neurofilaments as a plasma biomarker for ICU-acquired weakness:an observational pilot study[J]. Crit Care, 2014, 18(1): R18.
[29]
NICE-SUGAR Study Investigators, Finfer S,Chittock DR, et al. Intensive versus conventional glucose control in critically ill patients[J]. N Engl J Med, 2009, 360(13): 1283-1297.
[30]
Reade MC,Finfer S. Sedation and delirium in intensive care[J]. N Engl J Med, 2014, 370(16): 1567.
[31]
Burtin C,Clerckx B,Robbeets C, et al. Early exercise in critically ill patients enhances short-term functional recovery[J]. Crit Care Med, 2009, 37(9): 2499-2505.
[32]
Patel BK,Pohlman AS,Hall JB, et al. Impact of early mobilization on glycemic control and ICU-acquired weakness in critically ill patients who are mechanically ventilated[J]. Chest, 2014, 146(3): 583-589.
[33]
Maffiuletti NA,Roig M,Karatzanos E, et al. Neuromuscular electrical stimulation for preventing skeletal-muscle weakness and wasting in critically ill patients: a systematic review[J]. BMC Med, 2013, 11: 137.
[34]
Puthucheary ZA,Rawal J,McPhail M, et al. Acute skeletal muscle wasting in critical illness[J]. JAMA, 2013, 310(15): 1591-1600.
[35]
Hermans G,Casaer MP,Clerckx B, et al. Effect of tolerating macronutrient deficit on the development of intensive-care unit acquired weakness: a subanalysis of the EPaNIC trial[J]. Lancet Respir Med, 2013, 1(8): 621-629.
[36]
Needham DM,Dinglas VD,Bienvenu OJ, et al. One year outcomes in patients with acute lung injury randomised to initial trophic or full enteral feeding: prospective follow-up of EDEN randomised trial[J]. BMJ, 2013, 346: f1532.
[1] 杨水华, 何桂丹, 覃桂灿, 梁蒙凤, 罗艳合, 李雪芹, 唐娟松. 胎儿孤立性完全型肺静脉异位引流的超声心动图特征及高分辨率血流联合时间-空间相关成像的应用[J]. 中华医学超声杂志(电子版), 2023, 20(10): 1061-1067.
[2] 蒋佳纯, 王晓冰, 陈培荣, 许世豪. 血清学指标联合常规超声及超声造影评分诊断原发性干燥综合征的临床价值[J]. 中华医学超声杂志(电子版), 2023, 20(06): 622-630.
[3] 李培杰, 乔永杰, 张浩强, 曾健康, 谭飞, 李嘉欢, 王静, 周胜虎. 细菌培养阴性的假体周围感染诊治的最新进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 827-833.
[4] 彭旭, 邵永孚, 李铎, 邹瑞, 邢贞明. 结肠肝曲癌的诊断和外科治疗[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 108-110.
[5] 李智铭, 郭晨明, 庄晓晨, 候雪琴, 高军喜. 早期乳腺癌超声造影定性及定量指标的对比研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 639-643.
[6] 杨雪, 张伟, 尚培中, 宋创业, 尚丹丹, 张蔚. 胆囊十二指肠瘘结石经瘘口排出后自愈一例报道[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 707-708.
[7] 姜明, 罗锐, 龙成超. 闭孔疝的诊断与治疗:10年73例患者诊疗经验总结[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 706-710.
[8] 许丁伟, 马江云, 李新成, 黄洁. Alagille综合征疑诊为先天性胆道闭锁一例并文献复习[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 681-687.
[9] 蓝冰, 王怀明, 王辉, 马波. 局部晚期结肠癌膀胱浸润的研究进展[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 505-511.
[10] 杨红杰, 张智春, 孙轶. 直肠癌淋巴结转移诊断研究进展[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 512-518.
[11] 顾睿祈, 方洪生, 蔡国响. 循环肿瘤DNA检测在结直肠癌诊治中的应用与进展[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 453-459.
[12] 赵立力, 王魁向, 张小冲, 李志远. 血沉与C-反应蛋白比值在假体周围感染中的诊断价值分析[J]. 中华老年骨科与康复电子杂志, 2023, 09(06): 351-355.
[13] 袁媛, 赵良平, 刘智慧, 张丽萍, 谭丽梅, 閤梦琴. 子宫内膜癌组织中miR-25-3p、PTEN的表达及与病理参数的关系[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1016-1020.
[14] 李田, 徐洪, 刘和亮. 尘肺病的相关研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 900-905.
[15] 周婷, 孙培培, 张二明, 安欣华, 向平超. 北京市石景山区40岁及以上居民慢性阻塞性肺疾病诊断现状调查[J]. 中华临床医师杂志(电子版), 2023, 17(07): 790-797.
阅读次数
全文


摘要