关注重症监护病房获得性肌无力123课件

关注重症监护病房获得性肌无力

FocusonICU-AW关注重症监护病房获得性肌无力123感觉

有点不可思议。。。关注重症监护病房获得性肌无力123当患者出现撤机困难时。。。肺部原发疾病心功能液体负荷电解质紊乱镇静药物神经系统…….关注重症监护病房获得性肌无力123可能会忽略。。。IntensivecareunitacquiredweaknessICU-AWICU获得性肌无力关注重症监护病房获得性肌无力123实际情况全球每年有1300—2000万人因需生命支持入住ICU.美国每年有75万人接受机械通气，其中30万人>5天以上将近25%的机械通气将发生ICU-AWICU-AW:全球100万美国7.5万关注重症监护病房获得性肌无力123定义DefinitionICUAWisasyndromeofgeneralizedlimbweaknessthatdevelopswhilethepatientiscriticallyillandforwhichthereisnoalternativeexplanationotherthanthecriticalillnessitselfICU获得性肌无力是指重症患者所发生的、以肢体肌力减弱为主要表现，除了疾病本身无其他原因可以解释的一类综合征。（膈肌及肋间肌？？）关注重症监护病房获得性肌无力123ClinicalfeaturesassociatedwithICU-AW

关注重症监护病房获得性肌无力123ICU-AW

危重病性肌病

(criticalillnessmyopathy，CIM)

危重病性多发性神经病

(criticalillnesspolyneuropathy，CIP)

危重病性多发性神经肌肉病

(criticalillnesspolyneuromyopathy，CIPNM)CIM和/或CIP是ICU-AW的主要原因关注重症监护病房获得性肌无力123病因SIRS和MODS高血糖皮质激素的应用神经肌肉阻滞剂长期卧床、活动限制、延迟自主性物理运动。。。。关注重症监护病房获得性肌无力123关注重症监护病房获得性肌无力123SIRS/MODS引起ICU-AWHematoxylinandeosin(HE)stainingshowinginflammatorycellinfiltrateintomuscleincriticalillnessmyopathy.微血管受损缺血\神经损伤\肌肉细胞凋亡\肌细胞丢失关注重症监护病房获得性肌无力123病理改变SelectivethickfilamentlossPredominanttypeIImusclefibreatrophyMusclemembraneinexcitabilityJCachexiaSarcopeniaMuscle(2010)1:147–157

关注重症监护病房获得性肌无力123关注重症监护病房获得性肌无力123关注重症监护病房获得性肌无力123ICU住院时间与肌肉密度的关系Experimentsinhealthyvolunteersrevealthatmuscleatrophybeginswithinhoursofimmobility,14resultingina4–5%lossofmusclestrengthforeachweekofbedrest.TheinteractionofcriticalillnesswithimmobilitymayleadtoevengreatermusclelossImmobilityandDisuseAtrophy约束/制动的影响关注重症监护病房获得性肌无力123ICU-AW后果脱机失败或脱机时间延长肢体功能障碍死亡率增高关注重症监护病房获得性肌无力123EarlymobilizationandrecoveryinmechanicallyventilatedpatientsintheICU:abi-national,multi-centre,prospectivecohortstudy关注重症监护病房获得性肌无力123诊断关注重症监护病房获得性肌无力123诊断关注重症监护病房获得性肌无力123MEDICALRESEARCHCOUNCILSCALE(MRCS)关注重症监护病房获得性肌无力123ICU-AW电生理学特征刺激运动神经干,诱发所刺激神经支配的肌肉.在该肌肉记录运动电位,称为复合肌肉动作电位,CMAP(compoundmuscleactionpotential)刺激远端神经，在近端神经干记录动作电位，称之为感觉神经动作电位SNAP(Sensorynerveactionpotential)关注重症监护病房获得性肌无力123超声关注重症监护病房获得性肌无力123关注重症监护病房获得性肌无力123关注重症监护病房获得性肌无力123Howtodo?关注重症监护病房获得性肌无力123关注重症监护病房获得性肌无力123thetreatmentgroupperformedapassiveoractiveexercisetrainingsessionfor20mins/day,usingabedsideergometer.关注重症监护病房获得性肌无力123结果Figure3.A,Boxplotof6MWDathospitaldischarge.6MWD,6-minwalkingdistance.*p<.05comparedwithcontrolgroup.IsometricquadricepsforceatICUdischargeandathospitaldischarge.QF,quadricepsforce;hospital,dayofhospitaldischarge.*p<.01betweenICUandhospitaldischarge;†p<.05comparedwithcontrolgroup关注重症监护病房获得性肌无力123

Conclusions:Earlyexercisetrainingincriticallyillintensivecareunitsurvivorsenhancedrecoveryoffunctionalexercisecapacity,self-perceivedfunctionalstatus,andmuscleforceathospitaldischarge.

结论：早期功能锻炼可以提高ICU存活患者肌肉力量、功能锻炼恢复能力和自我感觉状态。关注重症监护病房获得性肌无力123关注重症监护病房获得性肌无力123关注重症监护病房获得性肌无力123关注重症监护病房获得性肌无力123p=0.048关注重症监护病房获得性肌无力123结论：虽然电刺激不能防止ICU-AW的发生，但可以减轻肌无力程度，帮助脱机。关注重症监护病房获得性肌无力123关注重症监护病房获得性肌无力123