重症多神經病變與肌肉病變的診斷、危險因子及預防方法

Diagnosis, risk factors and prevention of Critical Illness Polyneuropathy and Myopathy

李宜純(Yi-Chane Le) ； 許重梅(Chung-Mei Hsu) ； 謝慧觀(Huei-Guan Shie) ； 薛清香(Hsueh-Ching Hsiang) ； 李寶琳(Pao-Lin Lee) ； 林惠釧(Hui-Chuan Li)

《呼吸治療》 15卷2期 (2016/07) Pp. 37-49

https://doi.org/10.6269/JRT.2016.15.2.04

摘要

隨著醫療的進步，近年來重症個案的存活率增加，所以對這些重症存活者的預後開始有進一步的探討。許多研究發現重症後存活病人會有嚴重的神經肌肉病變，導致肌肉無力，呼吸器脫離困難、功能障礙和生活品質下降，及沉重的醫療負擔。早期的研究將重症多神經病變與重症肌肉病變分開討論，近年來發現兩者常出現在同一位病人身上且無法區分，故將重症後造成的肌肉無力，總稱為重症多神經病變與肌肉病變 (Criticalillness polyneuropathy and myopathy, CIPNM)。目前臨床上是使用傳統電生理學檢查診斷CIPNM，可以量化神經病變的嚴重程度，以醫學研究評分表(MRC score)輔助作為床邊的診斷工具，有助於早期發現個案的肌肉無力。針對此類重症病人，應避免危險因素如過度鎮靜、高劑量類固醇、肌肉鬆弛劑的使用、需控制血糖、增加營養的攝取，及早期的介入復健。目前較重視的預防方式，有嚴密的胰島素與肌肉電刺激治療，但確實的機轉仍不明確，希望能有更進一步的研究，找到預防與治療方法，以確保重症病患維持最佳的生活品質。

關鍵字

重症多神經病變與肌肉病變 ； 肌肉無力 ； 肌肉電刺激治療

並列摘要

As medical advances in recent years, the survival rate of critical cases tended to be increased. So the prognosis of these critical cases survivors began to have further discussion. Many studies found that the survivors had the severe neuromuscular disease and caused muscle weakness, weaning difficulty, functional dysfunction, decreased the quality of life and heavy medical burden. Previous studies discussed the severe polyneuropathy and severe muscle disease separately. In recent years, it found that they occurred in the same patient and could not be a clear distinction. Therefore muscle weakness after severe disease named as Critical Illness Polyneuropathy and Myopathy (CIPNM). The present clinical study is the used of traditional electrophysiological tests to diagnose CIPNM. It can quantify the severity of neuropathy. In addition to medical research score sheet (MRC score) assisted as bedside diagnostic tool that helped early detection of muscle weakness. For the critical illness, it should avoid the risk factors such as excessive sedation, high doses of steroids and use of muscle relaxants. It required blood sugar control, increased nutrition and early intervention rehabilitation. At present, more emphasis on the prevention such as strict insulin and muscle electrical stimulation therapy. However, the physiological mechanism was unclear. Further researches were needed for finding out the methods of prevention and treatment to ensure that patients have a quality of life.

並列關鍵字

Critical illness polyneuropathy and myopathy ； muscle weakness ； electrical musclestimulation