Critical Illness Myopathy in a Patient with Near-Fatal Asthma-A Case Report

瀕死性氣喘合併重症肌肉病變－病例報告

黃善建(Shan-Chien Huang) ； 郭弘周(Hung-Chou Kuo) ； 柯皓文(How-Wen Ko) ； 李岡遠(Kang-Yun Lee) ； 黃建達(Chien-Da Huang) ； 郭漢彬(Han-Pin Kuo)

《胸腔醫學》 23卷3期 (2008/06) Pp. 169-175

https://doi.org/10.29806/TM.200806.0003

摘要

神經肌肉無力的現象常發生在加護病房重症病人身上，病人預後也受神經肌肉病變而影響甚巨。急性肌肉病變常發生在病患有嚴重氣喘，且合併使用神經肌肉阻斷劑者。然而，這些病人大多沒有敗血症且缺乏肌肉切片的證據。在此提出的病例報告是一位41歲的男性病患，因瀕死性氣喘及敗血症而住進加護病房，在拔除氣管內管及停用鎮定劑後仍出現長時間肢體無力的情形。這病人在臨床上診斷重症肌肉病變主要是依據臨床表現、電生理檢查及肌肉切片。病人肌肉的力量在拔管後復健之中持續恢復。臨床上若及早注意及防止重症肌肉病變，則可降低併發症與死亡率，且可改善生活品質及節省醫療支出。

關鍵字

重症肌肉病變 ； 瀕死性氣喘 ； 敗血症 ； 神經學電生理檢查 ； 肌肉切片

並列摘要

Neuromuscular weakness is a common occurrence in patients who are critically ill in the intensive care unit (ICU). The prognosis of critically ill patients is significantly influenced by neuromuscular dysfunction. A higher incidence of acute myopathy has been reported in patients with acute severe asthma, especially those paralyzed with neuromuscular blocking agents. Nevertheless, most of the patients in these studies were free of sepsis and lacked a muscle biopsy analysis. Herein, we report a 41-year-old man with near-fatal asthma and sepsis who suffered from prolonged limb weakness without sedative agents after extubation. The clinical diagnosis for critical illness myopathy (CIM) in this patient was based on clinical manifestations, serial clinical electromyographic studies, and muscle biopsy. The muscle strength of this patient improved steadily after extubation and a rehabilitation program. Awareness of the occurrence and prevention of CIM contributes to the reduction of morbidity and mortality, improves life-quality and conserves medical resources.

並列關鍵字

critical illness myopathy ； near-fatal asthma ； sepsis ； electrophysiological test ； muscle biopsy