重症监护病房患者获得性肌无力的危险因素及诊断方法  

Risk factors and diagnostic methods of intensive care unit-acquired weakness

作　　者：冯会颖 詹庆元 黄絮[2] 翟天姝[2] 夏金根[2] 易丽[2] 张祎[2] 吴小静[2] 王芊霖[1,2] 黄琳娜 Feng Huiying;Zhan Qingyuan;Huang Xu;Zhai Tianshu;Xia Jin'gen;Yi Li;Zhang Yi;Wu Xiaojing;Wang Qianlin;Huang Linna(Graduate School of Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Respiratory Center,Department of Pulmonary and Critical Care Medicine,China-Japan Friendship Hospital,National Clinical Research Center for Respiratory Diseases,World Health Organization Collaborating Center for Tobacco Cessation and Respiratory Diseases Prevention,Beijing 100029,China)

机构地区：[1]中国医学科学院北京协和医学院研究生院,北京100730 [2]中日友好医院呼吸中心,呼吸与危重症医学科,国家呼吸疾病临床医学研究中心,世界卫生组织戒烟与呼吸疾病预防合作中心,北京100029

出　　处：《中华危重病急救医学》2021年第4期460-465,共6页Chinese Critical Care Medicine

基　　金：国家重点研发计划项目(2016YFC1304300)。

摘　　要：目的探讨重症监护病房(ICU)获得性肌无力(ICU-AW)的危险因素及MRC肌力评分量表评分(MRC评分)与肌电图特征。方法采用病例对照研究方法,选择中日友好医院呼吸与危重症医学科四部2018年9月至2020年1月收治的机械通气≥7 d且进行MRC评分的患者,按照MRC评分分为ICU-AW组(MRC评分<48分)及非ICU-AW组(MRC评分≥48分)。收集患者的一般情况、既往史、相关危险因素、MRC评分、呼吸支持方式、实验室检查结果、肌电图检查结果、ICU-AW相关治疗、转归及ICU住院时间等,比较两组间的差异。采用二分类多因素Logistic回归法分析ICU-AW的危险因素;并分析ICU-AW患者MRC评分与肌电图的特征。结果最终共60例患者纳入分析,其中ICU-AW组17例,非ICU-AW组43例。单变量分析显示,入ICU 1 d急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、脑钠肽(BNP)、血尿素氮(BUN)及有创机械通气比例在ICU-AW组与非ICU-AW组间比较差异均有统计学意义〔APACHEⅡ评分(分):21(18,25)比18(15,22),SOFA评分(分):7(5,12)比5(3,8),BNP(ng/L):364.3(210.1,551.2)比160.1(66.8,357.8),BUN(mmol/L):9.9(6.2,17.0)比6.0(4.8,9.8),有创机械通气比例:88.2%比46.5%,均P<0.05〕;二分类多因素Logistic回归分析未发现ICU-AW的独立危险因素。17例ICU-AW患者平均MRC评分为(33±11)分,表现为肢体无力呈对称性,且以近端肢体无力为主。肌电图检查结果显示,ICU-AW患者神经传导检查表现为复合肌肉动作电位(CMAP)和感觉神经动作电位(SNAP)波幅降低,可有传导速度减慢;针极肌电图检查提示运动单位电位(MUP)面积增加、时限延长及大量自发电位。预后评价显示,与非ICU-AW组相比,ICU-AW组中行气管切开的患者更多(70.6%比11.6%),ICU住院时间更长(d:57±52比16±8),进行康复治疗的患者也更多(58.8%比14.0%),差异均有统计学意义(均P<0.01)。结论ICU-AW的发生可能与患者入ICU 1 d内高APACHEⅡ、SOFAObjective To explore the risk factors of intensive care unit-acquired weakness(ICU-AW)and the characteristics of Medical Research Council(MRC)score and electromyogram.Methods A case control study was conducted.Patients with mechanical ventilation≥7 days and MRC score admitted to department of respiratory and critical care medicine of China-Japan Friendship Hospital from September 2018 to January 2020 were enrolled,and they were divided into ICU-AW group(MRC score<48)and non-ICU-AW group(MRC score≥48)according to MRC score.The general situation,past medical history,related risk factors,MRC score,respiratory support mode,laboratory examination results,electromyogram examination results,ICU-AW related treatment,outcome and length of ICU stay were collected,and the differences between the two groups were compared.The risk factors of ICU-AW were analyzed by binary multivariate Logistic regression,and the characteristics of MRC score and electromyogram were analyzed.Results A total of 60 patients were enrolled in the analysis,including 17 patients in ICU-AW group and 43 patients in non-ICU-AW group.Univariate analysis showed that there were significant differences in acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,sequential organ failure assessment(SOFA)score,brain natriuretic peptide(BNP),blood urea nitrogen(BUN)on the first day of ICU admission and the ratio of invasive mechanical ventilation between ICU-AW group and non-ICU-AW group[APACHEⅡscore:21(18,25)vs.18(15,22),SOFA score:7(5,12)vs.5(3,8),BNP(ng/L):364.3(210.1,551.2)vs.160.1(66.8,357.8),BUN(mmol/L):9.9(6.2,17.0)vs.6.0(4.8,9.8),invasive mechanical ventilation ratio:88.2%vs.46.5%,all P<0.05].Binary multivariate Logistic regression analysis showed no independent risk factor for ICU-AW.The average MRC score of 17 ICU-AW patients was 33±11.The limb weakness was symmetrical,and the proximal limb weakness was the main manifestation.Electromyography examination showed that the results of nerve conduction examination in ICU-AW patients mainly

关 键 词：ICU获得性肌无力 危险因素 MRC评分 肌电图 

分 类 号：R746.1[医药卫生—神经病学与精神病学]