關(guān)注重癥監(jiān)護(hù)病房獲得性肌無(wú)力課件

1、關(guān)注重癥監(jiān)護(hù)病房獲得性肌無(wú)力 Focus on ICU-AW關(guān)注重癥監(jiān)護(hù)病房獲得性肌無(wú)力 Focus on感覺(jué) 有點(diǎn)不可思議。感覺(jué) 有點(diǎn)不可思議。當(dāng)患者出現(xiàn)撤機(jī)困難時(shí)。肺部原發(fā)疾病心功能液體負(fù)荷電解質(zhì)紊亂鎮(zhèn)靜藥物神經(jīng)系統(tǒng).當(dāng)患者出現(xiàn)撤機(jī)困難時(shí)。肺部原發(fā)疾病可能會(huì)忽略。Intensive care unit acquired weakness ICU-AW ICU獲得性肌無(wú)力可能會(huì)忽略。Intensive care unit ac實(shí)際情況全球每年有13002000萬(wàn)人因需生命支持入住ICU.美國(guó)每年有75萬(wàn)人接受機(jī)械通氣，其中30萬(wàn)人5天以上將近25%的機(jī)械通氣將發(fā)生ICU-AWICU-AW:全

2、球 100萬(wàn) 美國(guó) 7.5 萬(wàn) 實(shí)際情況全球每年有13002000萬(wàn)人因需生命支持入住IC定義 Definition ICUAW is a syndrome of generalized limb weakness that develops while the patient is critically ill and for which there is no alternative explanation other than the critical illness itself ICU獲得性肌無(wú)力是指重癥患者所發(fā)生的、以肢體肌力減弱為主要表現(xiàn)，除了疾病本身無(wú)其他原因可以解釋的一類(lèi)綜合

3、征。（膈肌及肋間??？）定義 Definition ICUAW is a sClinical features associated with ICU-AW Clinical features associated wICU-AW 危重病性肌病 ( critical illness myopathy ，CIM) 危重病性多發(fā)性神經(jīng)病 ( critical illness polyneuropathy，CIP ) 危重病性多發(fā)性神經(jīng)肌肉病 ( critical illness polyneuromyopathy ，CIPNM) CIM 和/ 或CIP 是ICU-AW的主要原因ICU-AW 危重病性

4、肌病病因SIRS和MODS高血糖皮質(zhì)激素的應(yīng)用神經(jīng)肌肉阻滯劑長(zhǎng)期臥床、活動(dòng)限制、延遲自主性物理運(yùn)動(dòng)。病因SIRS和MODS關(guān)注重癥監(jiān)護(hù)病房獲得性肌無(wú)力課件SIRS/MODS引起ICU-AWHematoxylin and eosin (HE) staining showing inflammatory cell infiltrate into muscle incritical illness myopathy.微血管受損缺血神經(jīng)損傷肌肉細(xì)胞凋亡肌細(xì)胞丟失SIRS/MODS引起ICU-AWHematoxylin a病理改變Selective thick filament loss Predomi

5、nant type II muscle fibre atrophy Muscle membrane inexcitability J Cachexia Sarcopenia Muscle (2010) 1:147157 病理改變Selective thick filament l關(guān)注重癥監(jiān)護(hù)病房獲得性肌無(wú)力課件關(guān)注重癥監(jiān)護(hù)病房獲得性肌無(wú)力課件ICU住院時(shí)間與肌肉密度的關(guān)系Experiments in healthy volunteers reveal that muscle atrophy begins within hours of immobility,14 resulting in a

6、45% loss of muscle strength for each week of bed rest. The interaction of critical illness with immobility may lead to even greater muscle lossImmobility and Disuse Atrophy約束/制動(dòng)的影響ICU住院時(shí)間與肌肉密度的關(guān)系Experiments in ICU-AW后果脫機(jī)失敗或脫機(jī)時(shí)間延長(zhǎng)肢體功能障礙死亡率增高ICU-AW后果脫機(jī)失敗或脫機(jī)時(shí)間延長(zhǎng)Early mobilization and recovery in mechan

7、ically ventilated patients in the ICU: a bi-national,multi-centre, prospective cohort studyEarly mobilization and recover診斷診斷診斷診斷MEDICAL RESEARCH COUNCIL SCALE (MRCS)MEDICAL RESEARCH COUNCIL SCALEICU-AW 電生理學(xué)特征刺激運(yùn)動(dòng)神經(jīng)干,誘發(fā)所刺激神經(jīng)支配的肌肉.在該肌肉記錄運(yùn)動(dòng)電位,稱(chēng)為復(fù)合肌肉動(dòng)作電位, CMAP(compound muscle action potential) 刺激遠(yuǎn)端神經(jīng)，在

8、近端神經(jīng)干記錄動(dòng)作電位，稱(chēng)之為感覺(jué)神經(jīng)動(dòng)作電位SNAP(Sensory nerve action potential)ICU-AW 電生理學(xué)特征刺激運(yùn)動(dòng)神經(jīng)干,誘發(fā)所刺激神經(jīng)支配超聲超聲關(guān)注重癥監(jiān)護(hù)病房獲得性肌無(wú)力課件關(guān)注重癥監(jiān)護(hù)病房獲得性肌無(wú)力課件How to do?How to do?關(guān)注重癥監(jiān)護(hù)病房獲得性肌無(wú)力課件 the treatment group performed a passive or active exercise training session for 20 mins/day,using a bedside ergometer. the treatment group

9、 per結(jié)果Figure 3. A, Boxplot of 6MWD at hospital discharge. 6MWD, 6-min walking distance. *p .05 compared with control group.Isometric quadriceps force at ICU discharge and at hospital discharge.QF, quadriceps force; hospital, day of hospital discharge. *p.01 between ICU andhospital discharge; p.05 co

10、mpared with control group結(jié)果Figure 3. A, Boxplot of 6MWD Conclusions :Early exercise training in critically ill intensive care unit survivors enhanced recovery of functional exercise capacity, self-perceived functional status, and muscle force at hospital discharge. 結(jié)論：早期功能鍛煉可以提高ICU存活患者肌肉力量、功能鍛煉恢復(fù)能力和自我感覺(jué)狀態(tài)。關(guān)注重癥監(jiān)護(hù)病房獲得性肌無(wú)力課件關(guān)注重癥監(jiān)護(hù)病房獲得性肌無(wú)力課件關(guān)注重癥監(jiān)護(hù)病房獲得性肌無(wú)力課件關(guān)注重癥監(jiān)護(hù)病房獲得性肌無(wú)力課件 p = 0.048 p = 0.048結(jié)論：雖然電刺激不能防止ICU-AW的發(fā)生，但可以減輕肌無(wú)力程度，幫助脫機(jī)。結(jié)論：雖然電刺激不能防止ICU-AW的發(fā)生，但可以減輕肌無(wú)力關(guān)注重癥監(jiān)護(hù)病房獲得性肌無(wú)力課件關(guān)注重癥監(jiān)護(hù)病房獲得性肌無(wú)力課件關(guān)注重癥監(jiān)護(hù)病房獲得性