重症多神經病變和肌肉病變

Critical Illness Polyneuropathy and Myopathy

汪子瑄(Tze-Hsuan Wang) ； 吳英黛(Ying-Tai Wu)

《物理治療》 31卷1期 (2006/02) Pp. 46-54

摘要

重症多神經和肌肉病變是指重症病人，如敗血症、多重器官衰竭患者，因重症而非原發之神經或肌肉病變。臨床表徵包括嚴重的肌肉無力和萎縮，會嚴重影響患者肢體動作表現、延後呼吸器的拔除，增加停留加護病房日數、住院天數和住院死亡率，有些存活者還會長期功能不足，其四肢癱瘓無力的現象與一般長期臥床和肢體缺乏活動造成的肌肉無力不同。重症多神經病變為急性軸突神經病變，使骨骼肌去神經化，發生率的報導從22-82%都有。重症肌肉病變的發生率與之相似，需做肌肉的活體切片以確定診斷。很多重症多神經病變患者同時也有重症肌肉病變。本文主要在介紹此病變之臨床表徵、診斷方式、病理機轉、預防、治療方法及預後，以提供物理治療師在照護重症病人之參考。我們認為重症患者若出現不尋常的肢體無力現象時，應提醒照護團隊注意，在確定診斷後應擬定物理治療計畫以協助病患呼吸器之脫離與肢體功能之恢復，並長期追蹤其活動及社會參與情形。

關鍵字

重症多神經病變 ； 重症肌肉病變 ； 物理治療

並列摘要

Critical illness polyneuropathy and myopathy refers to severe muscle weakness and atrophy in patients with critical illness, such as sepsis or multiple organ failure. The problem often impaired patients' limb movement and function, prolonged their ventilator dependence, and increased the length of stay in intensive care unit and hospital and in-hospital mortality. It was different from the weakness from prolonged immobility and might persist in long-term survivors that limited their body function, activity, and social participation. Critical illness polyneuropathy (CIP) causes acute axonal injury in peripheral nerves and muscle denervation. The reported incidence of CIP varied from 22% to 82%. To diagnose critical illness myopathy (CIM) requires muscle biopsy. The incidence of CIM was similar to CIP in critical patients and CIM may coexist with CIP. The purpose of this review was to describe the clinical manifestations, diagnostic methods, pathogenesis, prevention, treatment, and prognosis of CIP and CIM. We concluded that physical therapists should be aware of the problems associated with critical illness polyneuropathy and myopathy, notify the existence to other team members, make the treatment plan to assist patients weaning from ventilator, promote their recovery of body function, and follow up their long-term activity level and social participation.

並列關鍵字

Critical illness polyneuropathy ； Critical illness myopathy ； Physical therapy