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危重病相关的神经肌肉源性肌无力

Author
David Lacomis, MD
Section Editor
Jeremy M Shefner, MD, PhD
Deputy Editor
John F Dashe, MD, PhD
Translators
谢琰臣, 副主任医师，副教授

引言

神经肌肉源性肌无力在危重病患者中经常发生，在入住重症监护病房(intensive care unit, ICU)并维持机械通气至少7日的患者中，其发生率大于等于25%[1]。肌无力在一定程度上是多器官衰竭和脓毒症患者生存情况改善的结果，但也是在ICU中所进行的治疗的结果，包括静脉内给予糖皮质激素以及有时给予肌松剂。

ICU中神经肌肉源性肌无力最常见的原因是危重病性肌病(critical illness myopathy, CIM)或危重病性多神经病(critical illness polyneuropathy, CIP)。本专题将总结危重病的外周神经肌肉性疾病。

鉴别诊断

对于出现广泛性弛缓性肌无力的危重病患者，鉴别诊断中主要考虑的是CIM和CIP，或两者兼有。神经肌肉接头处长时间阻滞的情况罕见。下文将详细讨论以上每种疾病。

在危重病患者中，可发生其他急性和亚急性肌病，包括横纹肌溶解和恶病质肌病。此外，在ICU中也可发生罕见的急性神经病(如，吉兰-巴雷综合征)。

横纹肌溶解 — 由于其疾病本身或所用的药物，某些危重病患者可发生横纹肌溶解[2]。 (参见“横纹肌溶解的临床表现与诊断”)

                    

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Literature review current through: 2017-06 . | This topic last updated: 2016-12-04.
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