重症疾病性神经肌肉病英文.pptxVIP

重症疾病性神经肌肉病英文第1页/共40页 AbbreviationsCIP critical illness polyneuropathyCIM critical illness myopathyCMAP compound muscl action potentialsSNAP sensory nerve action potentialEMG electromyogramSIRS systematic inflammatory response syndrome第2页/共40页 HISTORICAL REVIEWIn 1955 observed a polyneuropathy after shock or cardiac arrestIn 1961 described “coma-polyneuropathies” In 1971 described a polyneuropathy in patients with burnsin 1977 severe polyneuropathy about septic patients第3页/共40页 By 1983 the term “critical illness polyneuropathy”（CIP） was appliedRecently the termed “critical illness myopathy ”（CIM） was applied第4页/共40页 Studies about AetiologyvariouslyThe various factors associated with the SIRS CIP and CIM (Fig. 1) A simplified depiction of theoretical mechanisms of dysfunction in CIP and CIM.(Fig. 2 )Disorder of microcirculation（Fig. 3)第5页/共40页 Adapted with permission from Bolton.Figure. 1第6页/共40页 Adapted with permission fromBolton25.Figure. 2第7页/共40页 Figure.3 Schematic, theoretical presentation of disturbances in the microcirculation to various organs, including brain, peripheral nerve, and muscle, in SIRS.第8页/共40页 第9页/共40页 Incidence 50%–70% SIRS 20%–50% ICU第10页/共40页 ? Weakness of limb and respiratory muscle ? Tendon reflexes absent or decrease ?Distal loss to pain, temperature, and vibrationClinical Features第11页/共40页 The diagnostic criteria for CIP are shown in following TableDiagnosis第12页/共40页 Diagnostic criteria for CIPThe patient is critically ill (sepsis and multiple organ failure,SIRS)Difficulty weaning patient from ventilator afternonneuromuscular causes such as heart and lung diseasehave been excludedPossible limb weaknessElectrophysiologic evidence of axonal motor and sensory polyneuropathy第13页/共40页 Decline in the CMAP amplitude firstly (Fig. 4)Dcline in the SNAP amplitudeMotor unit potentials may be reduced in numberSingle-fiber EMG indicate dysfunction of terminal motor axonsElectrophysiologic Features第14