危重病性多发性神经肌病电生理特点及对机械通气的影响  

Electrophysiology characteristic of critical illness polyneuromyopathy and its effect on the duration of mechanical ventilation

作　　者：张哲成[1] 刘娜[1] 李斌[1] 邢国平[1] 

机构地区：[1]天津市第三中心医院神经内科,300170

出　　处：《中华神经科杂志》2009年第3期157-160,共4页Chinese Journal of Neurology

摘　　要：目的浅析危重病性多发性神经肌病（CIPM）的电生理特点及对机械通气支持时间的影响。方法应用丹麦Keypoint4肌电图仪对重症监护病房中17例机械通气时间〉1周仍未能脱机的肺部感染致呼吸衰竭患者进行神经电生理检测，观察其电生理特点并比较CIPM与非CIPM患者的机械通气时间。结果17例患者中CIPM9例，其中亚型危重病性多发性神经病（CIP）6例，危重病性肌病（CIM）3例。CIPM患者均表现四肢交感神经皮肤反应（SSR）异常和复合肌肉动作电位（CMAP）下降，CIP患者伴有感觉神经动作电位（SNAP）波幅减低而神经传导速度（NCV）正常。除2例CIP和2例CIM患者F波出现率减低外，全部CIPM患者重复神经电刺激、体感诱发电位及瞬目反射检测均正常。CIPM患者机械通气时间中位数（四分位数范围）为30．0d（20。0～45．0d），比非CIPM患者13．5d（9．5～17．5d）明显延长（U=7．500，P=0．006）。结论CIPM患者主要表现为CMAP和（或）SNAP波幅的减低，而NCV正常，全部患者SSR异常且脱机时间延长。Objective To analyze the electrophysiologic characteristics of critical illness of polyneuromyopathy （CIPM） and its effect on the duration of usage of mechanical ventilation. Methods Denmark Keypoint 4-electromyogram was utilized to record electroneurophysiology on 17 subjects with lung infection and respiratory failure who were treated with mechanical ventilation over 1 week and had difficulty in weaning from the ventilator in intensive care unit. Electrophysiology character of CIPM was described and the duration of mechanical ventilation of CIPM patients was compared with non-CIPM subjects. Results Of the 17 cases, 9 subjects were diagnosed with CIPM including 6 patients with critical illness polyneuropathy （CIP）, and 3 patients with critical illness myopathy （CIM）, the 2 subtype of CIPM. Compound muscle action potential （CMAP） and sympathetic skin response （SSR） in all of CIPM patients were abnormal. Though the amplitude of sensory nerve action potential （SNAP） in patients with CIP was reduced, nerve conduction velocity （NCV） was normal in all of then~ Repetitive nerve stimulation, somatosensory evoked potential and blink reflex were normal in all of the patients with CIPM, however, the rate of occurrence of F wave was reduced in 2 patients with CIP and in 2 patients with CIM. The median and quartile range of duration of mechanical ventilation in CIPM patients was 30. 0 days （20. 0--45.0 days）, significantly longer than 13.5 days （9.5--17.5 days） in non-CIPM patients （U=7.500,P=0. 006）. Conclusions The electrophysiology change in patients with CIPM is characterized by reduced amplitude of CMAP and （or） SNAP, normal NCV and abnormal SSR. The duration of mechanical ventilation is significantly prolonged in CIPM patients.

关 键 词：多发性神经病 肌疾病 电生理学 呼吸 人工 

分 类 号：R686[医药卫生—骨科学]