關(guān)注重癥監(jiān)護病房獲得性肌無力123課件

關(guān)注重癥監(jiān)護病房獲得性肌無力

FocusonICU-AW關(guān)注重癥監(jiān)護病房獲得性肌無力123感覺

有點不可思議。。。關(guān)注重癥監(jiān)護病房獲得性肌無力123當(dāng)患者出現(xiàn)撤機困難時。。。肺部原發(fā)疾病心功能液體負(fù)荷電解質(zhì)紊亂鎮(zhèn)靜藥物神經(jīng)系統(tǒng)…….關(guān)注重癥監(jiān)護病房獲得性肌無力123可能會忽略。。。IntensivecareunitacquiredweaknessICU-AWICU獲得性肌無力關(guān)注重癥監(jiān)護病房獲得性肌無力123實際情況全球每年有1300—2000萬人因需生命支持入住ICU.美國每年有75萬人接受機械通氣，其中30萬人>5天以上將近25%的機械通氣將發(fā)生ICU-AWICU-AW:全球100萬美國7.5萬關(guān)注重癥監(jiān)護病房獲得性肌無力123定義DefinitionICUAWisasyndromeofgeneralizedlimbweaknessthatdevelopswhilethepatientiscriticallyillandforwhichthereisnoalternativeexplanationotherthanthecriticalillnessitselfICU獲得性肌無力是指重癥患者所發(fā)生的、以肢體肌力減弱為主要表現(xiàn)，除了疾病本身無其他原因可以解釋的一類綜合征。（膈肌及肋間肌？？）關(guān)注重癥監(jiān)護病房獲得性肌無力123ClinicalfeaturesassociatedwithICU-AW

關(guān)注重癥監(jiān)護病房獲得性肌無力123ICU-AW

危重病性肌病

(criticalillnessmyopathy，CIM)

危重病性多發(fā)性神經(jīng)病

(criticalillnesspolyneuropathy，CIP)

危重病性多發(fā)性神經(jīng)肌肉病

(criticalillnesspolyneuromyopathy，CIPNM)CIM和/或CIP是ICU-AW的主要原因關(guān)注重癥監(jiān)護病房獲得性肌無力123病因SIRS和MODS高血糖皮質(zhì)激素的應(yīng)用神經(jīng)肌肉阻滯劑長期臥床、活動限制、延遲自主性物理運動。。。。關(guān)注重癥監(jiān)護病房獲得性肌無力123關(guān)注重癥監(jiān)護病房獲得性肌無力123SIRS/MODS引起ICU-AWHematoxylinandeosin(HE)stainingshowinginflammatorycellinfiltrateintomuscleincriticalillnessmyopathy.微血管受損缺血\神經(jīng)損傷\肌肉細(xì)胞凋亡\肌細(xì)胞丟失關(guān)注重癥監(jiān)護病房獲得性肌無力123病理改變SelectivethickfilamentlossPredominanttypeIImusclefibreatrophyMusclemembraneinexcitabilityJCachexiaSarcopeniaMuscle(2010)1:147–157

關(guān)注重癥監(jiān)護病房獲得性肌無力123關(guān)注重癥監(jiān)護病房獲得性肌無力123關(guān)注重癥監(jiān)護病房獲得性肌無力123ICU住院時間與肌肉密度的關(guān)系Experimentsinhealthyvolunteersrevealthatmuscleatrophybeginswithinhoursofimmobility,14resultingina4–5%lossofmusclestrengthforeachweekofbedrest.TheinteractionofcriticalillnesswithimmobilitymayleadtoevengreatermusclelossImmobilityandDisuseAtrophy約束/制動的影響關(guān)注重癥監(jiān)護病房獲得性肌無力123ICU-AW后果脫機失敗或脫機時間延長肢體功能障礙死亡率增高關(guān)注重癥監(jiān)護病房獲得性肌無力123EarlymobilizationandrecoveryinmechanicallyventilatedpatientsintheICU:abi-national,multi-centre,prospectivecohortstudy關(guān)注重癥監(jiān)護病房獲得性肌無力123診斷關(guān)注重癥監(jiān)護病房獲得性肌無力123診斷關(guān)注重癥監(jiān)護病房獲得性肌無力123MEDICALRESEARCHCOUNCILSCALE(MRCS)關(guān)注重癥監(jiān)護病房獲得性肌無力123ICU-AW電生理學(xué)特征刺激運動神經(jīng)干,誘發(fā)所刺激神經(jīng)支配的肌肉.在該肌肉記錄運動電位,稱為復(fù)合肌肉動作電位,CMAP(compoundmuscleactionpotential)刺激遠(yuǎn)端神經(jīng)，在近端神經(jīng)干記錄動作電位，稱之為感覺神經(jīng)動作電位SNAP(Sensorynerveactionpotential)關(guān)注重癥監(jiān)護病房獲得性肌無力123超聲關(guān)注重癥監(jiān)護病房獲得性肌無力123關(guān)注重癥監(jiān)護病房獲得性肌無力123關(guān)注重癥監(jiān)護病房獲得性肌無力123Howtodo?關(guān)注重癥監(jiān)護病房獲得性肌無力123關(guān)注重癥監(jiān)護病房獲得性肌無力123thetreatmentgroupperformedapassiveoractiveexercisetrainingsessionfor20mins/day,usingabedsideergometer.關(guān)注重癥監(jiān)護病房獲得性肌無力123結(jié)果Figure3.A,Boxplotof6MWDathospitaldischarge.6MWD,6-minwalkingdistance.*p<.05comparedwithcontrolgroup.IsometricquadricepsforceatICUdischargeandathospitaldischarge.QF,quadricepsforce;hospital,dayofhospitaldischarge.*p<.01betweenICUandhospitaldischarge;?p<.05comparedwithcontrolgroup關(guān)注重癥監(jiān)護病房獲得性肌無力123

Conclusions:Earlyexercisetrainingincriticallyillintensivecareunitsurvivorsenhancedrecoveryoffunctionalexercisecapacity,self-perceivedfunctionalstatus,andmuscleforceathospitaldischarge.

結(jié)論：早期功能鍛煉可以提高ICU存活患者肌肉力量、功能鍛煉恢復(fù)能力和自我感覺狀態(tài)。關(guān)注重癥監(jiān)護病房獲得性肌無力123關(guān)注重癥監(jiān)護病房獲得性肌無力123關(guān)注重癥監(jiān)護病房獲得性肌無力123關(guān)注重癥監(jiān)護病房獲得性肌無力123p=0.048關(guān)注重癥監(jiān)護病房獲得性肌無力123結(jié)論：雖然電刺激不能防止ICU-AW的發(fā)生，但可以減輕肌無力程度，幫助脫機。關(guān)注重癥監(jiān)護病房獲得性肌無力123關(guān)注重癥監(jiān)護病房獲得性肌無力123