关注重症监护病房获得性肌无力ppt参考课件.pptVIP

MEDICAL RESEARCH COUNCIL SCALE (MRCS) * ICU-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(compound muscle action potential) 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 (Sensory nerve action potential) * 超声 * * * How to do? * * the treatment group performed a passive or active exercise training session for 20 mins/day,using a bedside ergometer. * 关注重症监护病房获得性肌无力 Focus on ICU-AW * 感觉  有点不可思议。。。 * 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 ……. * 可能会忽略。。。 Intensive care unit acquired weakness ICU-AW ICU获得性肌无力 * 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-AW ICU-AW:全球 100万 美国 7.5 万 * 定义 Definition ICUAW is a syndrome of generalized limb weakness that develops while the patient is critically ill and for which there is no alternative explanation other than the critical illness itself ICU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？？） * Clinical features associated with ICU-AW * ICU-AW 危重病性肌病 ( critical illness myopathy ，CIM) 危重病性多发性神经病 ( critical illness polyneuropathy，CIP ) 危重病性多发性神经肌肉病 ( critical illness polyneuromyopathy ，CIPNM) CIM 和/ 或CIP 是ICU-AW的主要原因 * 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 。。。。 * * SIRS/MODS引起ICU-AW Hematoxylin and eosin (HE) staining showing inflammatory cell infiltrate into muscle incritical illness myopathy. 微血管受损缺血\神经损伤\肌肉细胞凋亡\肌细胞丢失 * 病理改变 Selective thick filament loss Predominant type II muscle fibre atrophy Muscle membrane inexcitability J Cachexia Sarcopenia Muscle (2010) 1:147–157 * * * ICU住院时间与肌肉密度的关系 Experiments in healthy volunteers reveal that muscle atrophy begins within hours of immobility,14 resulting in a 4–5% loss of muscle strength for each week of bed rest. The interaction of critical illness with immobility may lead