重症疾病性神经肌肉病(英文课件)PPT.ppt

 CRITICAL ILLNESS NEUROMYOPATHY ; Abbreviations;HISTORICAL REVIEW; ; Studies about Aetiologyvariously; Figure.3 Schematic, theoretical presentation of disturbances in the microcirculation to various organs, including brain, peripheral nerve, and muscle, in SIRS.;; Incidence 50%–70% SIRS 20%–50% ICU ; ? Weakness of limb and respiratory muscle ? Tendon reflexes absent or decrease ?Distal loss to pain, temperature, and vibration; The diagnostic criteria for CIP are shown in following Table ; ; Decline in the CMAP amplitude firstly (Fig. 4) Dcline in the SNAP amplitude Motor unit potentials may be reduced in number Single-fiber EMG indicate dysfunction of terminal motor axons ;Measurement of compound thenar muscle action potentials at the onset of sepsis (A) and 3 weeks later (B).; Peripheral axonal degeneration. Moderate loss of dorsal root ganglion cells Central chromatolysis of anterior horn cells No inflammation in the peripheral nervous system ; ;; Axonal variants of Guillain–Barre′ syndrome Develop earlier Often associated with CJ infection Abnormal cerebral spinal fluid; ;Treatment of sepsis and multiple organ dysfunction syndrome Management of difficulty in weaning from the ventilator Attempts at direct treatment of CIP (still unproven) Physiotherapy and rehabilitation ; ;Recovery depends on the distance Recovery for weeks in mild cases and months in severe cases Slowing of nerve conduction may have a poor prognosis;;Incidence At least one-third of ICU patients（ treated for status asthmaticus） In 7% of patients after transplantation ; ; Diagnostic criteria of CIM ● SNAP amplitudes 80% of the lower limit of normal ● Needle EMG with short-duration, low-amplitude MUPs with early or normal full recruitment, with or without fibrillation potentials ● Absence of a decremental response on repetitive nerve stimulation ; ;Nerve conduction studies Low-amplitude CMAPs Long duration CMAPs Normal SNAPs Phrenic