急性急症多發性神經病變：病例報告

Critical Illness Polyneuropathy: A Case Report

王錦滿(Chin-Man Wang) ； 李麗芳(Li-Fang Lee) ； 陳芝琪(Chu-Chi Chen) ； 黃美涓(Alice M.K. Wang) ； 鄧復旦(Fuk-Tan Tang) ； 鄭寶釵(Pao-Tsai Cheng)

《台灣復健醫學雜誌》 33卷1期 (2005/03) Pp. 55-62

https://doi.org/10.6315/2005.33(1)07

摘要

臨床上急症病人常合併有急性肢體無力，因為有很多不同的病因，一般很難鑑別診斷。所謂的急性急症多發性神經病變(critical illness polyneuropathy)病因仍不明，約有50-70％的病人可能在一次重大感染之後，造成全身性發炎反應(systemic inflammatory response syndrome)及多器官系統失調症候群(multiple organ dysfunction syndrome)，合併發生的多發性神經病變。本病例報告一66歲男性，5年多前診斷爲糖尿病並以運動及飲食控制，2年多前發現遠端肢體麻木，但直至入院前並無肌無力或肌萎縮之現象，日常生活完全獨立，步態正常，四個月前肌肉拉傷併發感染在院外治療無效後轉至本院，入院後發現爲大腿內側近肛門處膿瘍，並接受兩次開刀及抗生素治療，因併發肺炎、肋膜積水、急性全身水腫之後發生非常明顯之肢體無力及肌萎縮，且日常生活需他人照顧，無法站力及步行能力，於是轉入復健科後安排神經傳導及肌電檢查，發現四肢多條神經有病變及多處肌肉急性去神經變化，病患雖有糖尿病病史，但病程之感染及急性發展，神經傳導及肌電檢查情形，符合急性急症多發性神經病變的診斷要件。本文討論病患在急性急症臥床後之肌萎縮或去功能性(deconditioning)狀態，需要與其它的多發性神經病變做鑑別診斷，以早期正確診斷，早期規劃復健治療，降低家屬疑慮，增進病患復健合作之意願。

關鍵字

急性急症 ； 多發性神經病變

並列摘要

It is often difficult to isolate the etiology of acute weakness in the critically ill population because of multiple etiologies. Recently, critical illness polyneuropathy (CIP), a syndrome of unknown etiology was added to the differential diagnosis. The frequency of CIP is approximately 50-70% in patient with sepsis and/or systemic inflammatory response syndrome and multiple organ dysfunction syndrome. This case report presents a 66 year-old male who has diabetic mellitus for five years. He suffered from distal limbs numbness without muscle atrophy for nearly two years. Prior to admission, he was treated as muscle strain over right thigh in another hospital repeatedly, but in vain. After admitted to our hospital, a thorough physical examination revealed an abscess formation near the medial aspect of the right thigh. The patient was transferred to the rehabilitation department due to significant intrinsic muscle atrophy and poor activities of daily life after antibiotics treatment and surgical intervention twice which complicated with pneumonia, pleural effusion and systemic edema. In addition, nerve conductive studies suggested of predominantly axonal motor peripheral polyneuropathy, affecting distal limbs while the electromyography studies revealed active denervation change affecting all limbs muscles. This study discussed a patient with CIP with the aim of early diagnosis of this condition. Such diagnosis may influence early management, improving performance and cooperation during the rehabilitation programs.

並列關鍵字

critical illness ； polyneuropathy