ICU获得性肌无力的高危因素分析及其对预后的影响  

Risk factors of ICU-acquired muscle weakness

作　　者：陈新国 徐建国 CHEN Xinguo;XU Jianguo(Department of Emergence,Wenzhou People's Hospital,Wenzhou 325000,China)

机构地区：[1]温州市人民医院急诊科,325000 [2]温州市人民医院ICU,325000

出　　处：《浙江医学》2018年第6期582-585,共4页Zhejiang Medical Journal

基　　金：温州市人民医院院内资助项目(2015007)

摘　　要：目的探讨ICU重症患者并发ICU获得性肌无力(ICU-AW)的高危因素。方法收集491例综合ICU及急诊EICU患者,根据是否并发ICU-AW,分为肌无力组和对照组,观察并比较两组患者在年龄、性别、高热、休克指数、APACHE II评分、严重脓毒症、多器官功能障碍、低氧血症、贫血、急性肾损伤、血浆高渗、低蛋白血症、高血糖、全静脉营养、应用血管活性药物、镇静剂、激素、神经肌肉阻滞剂、制动、机械通气时间、住ICU时间等方面的差异,然后纳入logistic回归分析,分析ICU患者并发ICU-AW的高危因素;同时,统计医源性高危因素对并发ICU-AW患者预后的影响。结果其中260例发生ICU-AW,导致发生的危险因素较多,包括年龄、休克、APACHEⅡ评分、严重脓毒症、多器官功能障碍、急性肾损伤、血浆高渗、高血糖、全静脉营养、镇静剂、神经肌肉阻滞剂、制动、机械通气时间、入住ICU时间;神经肌肉阻滞剂对ICU-AW患者预后有利。结论 ICU患者发生ICU-AW原因复杂,控制原发病是根本,尤其是感染,对于高危患者,建议采取综合性防控措施。神经肌肉阻滞剂对ICU-AW患者预后有利。Objective To investigate the risk factors of ICU-acquired muscle weakness.Methods Total 491 patients admitted in general ICU or emergency ICU were enrolled in this study,among whom ICU-acquired muscle weakness developed in 260 patients(muscle weakness group)and patients without muscle weakness served as the control group(n=231).The age,sex,hyperthermia,shock index,APACHEII score,severe sepsis,multiple organ dysfunction,hypoxemia,anemia,acute renal injury,plasma hyperosmosis,hypoproteinemia,hyperglycemia total intravenous nutrition,the application of vasoactive drugs,sedatives,hormones,neuromuscular blockers,braking,mechanical ventilation time,ICU stay were compared between the two groups.Binary logistic regression analysis was employed to assess the risk factors of ICU-acquired muscle weakness,and the impact of iatrogenic risk factors on prognosis of patients with ICU-acquired myasthenia gravis was also analyzed.Results Logistic regression analysis showed that age,shock,APACHEⅡscore,severe sepsis,multiple organ dysfunction,acute kidney injury,plasma hyperosmosis,hyperglycemia,total intravenous nutrition,sedatives,neuromuscular blockers,movement restraining,mechanical ventilation time,ICU time were the risk factors for ICU-acquired muscle weakness.The administration of neuromuscular blockers benefited the prognosis of patients.Conclusion The causes of ICU-acquired muscle weakness are complex;it is recommended to take comprehensive prevention and control measures for high-risk patients.Neuromuscular blockers benefited the prognosis of patients with ICU-acquired muscle weakness.

关 键 词：ICU ICU获得性肌无力 高危因素 神经肌肉阻滞剂 

分 类 号：R746[医药卫生—神经病学与精神病学]