Severe Critical Illness Polyneuropathy Resulting in Tetraplegia: A Complication of Sepsis and Multiple Organ Dysfunction Syndrome-A Case Report

嚴重的重症疾病併多發性神經病變導致四肢癱瘓：敗血症及多重器官失調症候群之併發症－病例報告

張明哲(Ming-Jhieh Chang) ； 吳燿光(Yao-Kuang Wu) ； 林孟志(Meng-Chih Lin) ； 蔡熒煌(Ying-Huang Tsai)

《胸腔醫學》 18卷5期 (2003/10) Pp. 449-454

https://doi.org/10.29806/TM.200310.0010

摘要

敗血症主要是由於感染引發之症候群，它會促進各不同器官的衰竭，如肺臟、心臟、腦部、肝臟、腸胃道及腎臟。此外，敗血症也會使週邊神經和骨骼肌受到損傷或功能異常而導致重症疾病併多發性神經病變及重症疾病併肌肉病變。重症疾病併多發性神經病變是指在敗血症或多重器官失調症候群的重症病人，所併發的急性瀰漫性軸突功能異常。我們在此報告一個患肺炎、敗血症及心臟和肺臟衰竭的75歲男性病人。在入加護病房住院第五天時發現四肢癱瘓及肌肉無力而且當敗血症已控制後卻仍然難以脫離呼吸器。為了找尋四肢癱瘓的原因我們做了詳盡的檢查，神經電氣生理學檢查確診為重症疾病併多發性神經病變。在嘗試脫離呼吸器之前的最大吸氣壓力為負10公分水柱。經過兩個月積極的肺部復原運動及治療敗血症，最大吸氣壓力到達負38公分水柱。病患的肌力緩慢而穩定的恢復。在出院後三個月，夜間仍需正壓呼吸器的使用。結論：當病患在加護病房的病危狀況受到控制後若仍有週邊肌力減弱及難以脫離呼吸器，此時我們應懷疑是否為重症疾病併多發性神經病變。確定診斷以及進行復健訓練對這些病人是必須的。

關鍵字

敗血症 ； 重症疾病併多發性神經病變 ； 多重器官失調症候群

並列摘要

Sepsis is a major infection-induced syndrome that promotes the failure of various organs such as the lung, heart, brain, liver, gastrointestinal tract, and kidney. In addition, sepsis can cause damage to or dysfunction of the peripheral nerves and skeletal muscles, leading to conditions called critical illness polyneuropathy (CIP) and critical illness myopathy (CIM). CIP is an acute, diffuse neuropathy due to axonal dysfunction appearing in critically ill patients with sepsis or multiple organ dysfunction syndromes. We report a 75-year-old male with pneumonia, sepsis, and heart and respiratory failure. He developed paralysis in the four extremities with flaccid muscle 5 days after admission to the intensive care unit (ICU), and delayed weaning once the sepsis was under control. Meticulous examinations had been performed to look for the cause of the tetraplegia before electrodiagnosis confirmed critical illness polyneuropathy. Before the weaning trial, the maximal inspiratory pressure (MIP) was -10 cmH2O. After 2 months of aggressive pulmonary rehabilitation exercise and sepsis treatment, the MIP reached -38 cmH2O. His muscle power recovered slowly but steadily. Nocturnal use of a positive airway pressure ventilator was still needed 3 months after discharge. We conclude that CIP should be suspected when a patient presents with decreased peripheral muscle power or difficulty weaning after controlling the underlying critical condition in the ICU. A confirmed diagnosis and rehabilitation training are necessary for these patients.

並列關鍵字

sepsis ； critical illness polyneuropathy ； multiple organ dysfunction syndrome