重症肺炎并脓毒症性肌病1例及文献回顾
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摘要
回顾成功救治的1例脓毒症性肌病患者的临床资料,并结合相关文献进行分析。该患者为中年女性,无基础疾病,因发热,咳嗽,胸闷,气促入院,治疗期间反复出现Ⅱ型呼吸衰竭,脱机困难,最终诊断为脓毒症性肌病,予以抗感染、康复训练等治疗后撤机成功,肌力恢复。该病例提示脓毒症性肌病通过早期识别,及尽早给予神经肌肉营养药物治疗及分级康复训练、肺康复治疗,可达到完全治愈。
Clinical data of one patient with sepsis-induced myopathy(SIM) who was successfully treated were reviewed retrospectively, analysis was conducted combined with the relevant literatures. Patient was a middle-aged woman without underlying disease, she was admitted to hospital because of fever, cough, chest tightness and shortness of breath, during the treatment period, type II respiratory failure occurred repeatedly, and it was difficult in withdrawing respirator, patient was finally diagnosed with SIM. After anti-infective treatment and rehabilitation training, she was successfully withdrawn respirator, muscle strength was recovered. This case suggests that SIM can be completely cured through early identification, neuromuscular nutrition therapy, graded rehabilitation training and lung rehabilitation therapy.
Clinical data of one patient with sepsis-induced myopathy(SIM) who was successfully treated were reviewed retrospectively, analysis was conducted combined with the relevant literatures. Patient was a middle-aged woman without underlying disease, she was admitted to hospital because of fever, cough, chest tightness and shortness of breath, during the treatment period, type II respiratory failure occurred repeatedly, and it was difficult in withdrawing respirator, patient was finally diagnosed with SIM. After anti-infective treatment and rehabilitation training, she was successfully withdrawn respirator, muscle strength was recovered. This case suggests that SIM can be completely cured through early identification, neuromuscular nutrition therapy, graded rehabilitation training and lung rehabilitation therapy.
引文
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[2] Aktar Kamal, 韩辉, 丁士芳, 等. 重症患者获得性肌无力17例临床分析[J]. 中华危重病急救医学, 2015,27(4):306-309.
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[11] Price DR, Mikkelsen ME, Umscheid CA, et al. Neuromuscular blocking agents and neuromuscular dysfunction acquired in critical illness: a systematic review and meta-analysis[J]. Crit Care Med, 2016, 44(11): 2070-2078.
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[13] 郭驹, 陈淑萍, 窦清理, 等. ICU重症多神经肌病诊治探讨(附4例报告)[J]. 齐鲁医学杂志, 2011,29(2):144-146.
[14] Desai SV, Law TJ, Needham DM. Long-term complications of critical care[J]. Crit Care Med, 2011, 39(2): 371-379.
[15] 叶林, 马强, 马永盛. 危重病多神经病和危重病肌病13例临床分析[J]. 中国医师进修杂志, 2007,30(2):66-67.
[16] Nayci A, Atis S, Comelekoglu U, et al. Sepsis induces early phrenic nerve neuropathy in rats[J]. Eur Respir J, 2005, 26(4): 686-692.
[17] Latronico N, Bolton CF. Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis[J]. Lancet Neurol, 2011, 10(10): 931-941.
[18] Apostolakis E, Papakonstantinou NA, Baikoussis NG, et al. Intensive care unit-related generalized neuromuscular weakness due to critical illness polyneuropathy/myopathy in critically ill patients[J]. J Anesth, 2015, 29(1): 112-121.
[19] Zochodne DW, Bolton CF, Wells GA, et al. Critical illness polyneuropathy. A complication of sepsis and multiple organ failure[J]. Brain, 1987, 110(Pt 4): 819-841.
[20] Hermans G, Van den Berghe G. Clinical review: intensive care unit acquired weakness[J]. Crit Care, 2015, 19: 274.
[21] 王洪亮, 章志丹, 黄伟. 拯救脓毒症运动:脓毒症与感染性休克治疗国际指南(2016)的解读与展望[J]. 中华重症医学电子杂志, 2017,3(1):26-32.
[22] 谢剑锋, 邱海波. 拯救脓毒症运动:脓毒症与感染性休克治疗国际指南(2016)的进展与评论[J]. 中华重症医学电子杂志, 2017,3(1):18-25.
[23] Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial[J]. Lancet, 2009, 373(9678): 1874-1882.
[24] Li H, Wu LM, Kong XB, et al. Reversible tetraplegia after percutaneous nephrostolithotomy and septic shock: a case of critical illness polyneuropathy and myopathy with acute onset and complete recovery[J]. BMC Nephrology, 2013, 14: 36.
[25] Saliba L, Cook CH, Dungan KM, et al. Medication-induced and spontaneous hypoglycemia carry the same risk for hospital mortality in critically ill patients[J]. J Crit Care, 2016, 36: 13-17.
[26] 王晨, 李俏俏. 重组生长激素对COPD合并呼吸衰竭患者应用呼吸机过程中的免疫保护作用[J]. 中国生化药物杂志, 2016,36(11):77-80.
[27] 王爱民, 刘伯毅, 方志成, 等. 老年患者胸腹部术后急性呼吸衰竭机械通气应用重组人生长激素的剂量探讨[J]. 临床肺科杂志, 2012,17(9):1589-1591.
[28] 应可, 陆红. 重组人生长激素治疗呼吸衰竭并脱机困难的临床观察[J]. 中国中医药咨讯, 2010,2(17):202.
[29] 柯卉, 黄海燕. 四级早期活动与康复锻炼疗法预防病人ICU获得性衰弱的效果观察[J]. 护理研究, 2016,30(6c):2202-2205.
[30] 何务晶, 黄玉莲, 李艳芳, 等. 分级康复训练对ICU机械通气患者肌力衰弱、压疮的影响[J]. 护理实践与研究, 2018,15(5):155-157.
[31] 张圣宇, 张兆波. 重症监护病房获得性肌无力的评估与早期康复干预[J]. 中国康复医学杂志, 2017,32(5):603-606.
[32] 吴娇华, 梁金清. 以呼吸肌功能锻炼为主的肺康复治疗在慢性肺部疾病中的应用研究进展[J]. 蛇志, 2014,26(1):97-99.
[33] 郭涛, 童华生. 心肺康复治疗在ICU获得性衰弱患者中的应用及效果观察[J]. 中国康复, 2017,32(5):383-385.
[34] 周兴强, 徐治波, 李汶静, 等. 早期肺康复训练对有创机械通气重症肺炎患者的影响[J]. 遵义医学院学报, 2016,39(5):503-507.
[2] Aktar Kamal, 韩辉, 丁士芳, 等. 重症患者获得性肌无力17例临床分析[J]. 中华危重病急救医学, 2015,27(4):306-309.
[3] Santos PD, Teixeira C, Savi A, et al. The critical illness polyneuropathy in septic patients with prolonged weaning from mechanical ventilation: is the diaphragm also affected? A pilot study[J]. Respir Care, 2012, 57(10): 1594-1601.
[4] Dong L, Wang S, Wang G, et al. Using gene set enrichment analysis to identify new genes involved in sepsis-induced myo-pathy[J]. Int J Clin Exp Med, 2016, 9(4): 7407-7416.
[5] Callahan LA, Supinski GS. Sepsis-induced myopathy[J]. Crit Care Med, 2009, 37(10 Suppl): S354-S367.
[6] 王海旭, 张晓娟, 段晓光, 等. ICU获得性肌无力的诊断与治疗[J]. 中华急诊医学杂志, 2017,26(10):1187-1190.
[7] Fan E, Cheek F, Chlan L, et al. An official American Thora-cic Society clinical practice guideline: the diagnosis of intensive care unit-acquired weakness in adults[J]. Am J Respir Crit Care Med, 2014, 190(12): 1437-1446.
[8] Godoy DA, Mello LVD, Masotti L, et al. Intensive care unit acquired weakness (ICU-AW): a brief and practical review[J]. Rev in Health Care, 2015, 6(1): 9-35.
[9] Prentice CE, Paratz JD, Bersten AD. Differences in the degree of respiratory and peripheral muscle impairment are evident on clinical, electrophysiological and biopsy testing in critically ill adults: a qualitative systematic review[J]. Crit Care Resusc, 2010, 12(2): 111-120.
[10] Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a new definition and assessing new clinical criteria for septic shock: for the third international consensus definitions for sepsis and septic shock (sepsis-3)[J]. JAMA, 2016, 315(8): 775-787.
[11] Price DR, Mikkelsen ME, Umscheid CA, et al. Neuromuscular blocking agents and neuromuscular dysfunction acquired in critical illness: a systematic review and meta-analysis[J]. Crit Care Med, 2016, 44(11): 2070-2078.
[12] 刘政疆,艾尔西丁·吾斯曼,薜克栋. ICU危重症获得性多发性神经病和肌病[J]. 中华临床医师杂志(电子版), 2011,5(6):1674-1676.
[13] 郭驹, 陈淑萍, 窦清理, 等. ICU重症多神经肌病诊治探讨(附4例报告)[J]. 齐鲁医学杂志, 2011,29(2):144-146.
[14] Desai SV, Law TJ, Needham DM. Long-term complications of critical care[J]. Crit Care Med, 2011, 39(2): 371-379.
[15] 叶林, 马强, 马永盛. 危重病多神经病和危重病肌病13例临床分析[J]. 中国医师进修杂志, 2007,30(2):66-67.
[16] Nayci A, Atis S, Comelekoglu U, et al. Sepsis induces early phrenic nerve neuropathy in rats[J]. Eur Respir J, 2005, 26(4): 686-692.
[17] Latronico N, Bolton CF. Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis[J]. Lancet Neurol, 2011, 10(10): 931-941.
[18] Apostolakis E, Papakonstantinou NA, Baikoussis NG, et al. Intensive care unit-related generalized neuromuscular weakness due to critical illness polyneuropathy/myopathy in critically ill patients[J]. J Anesth, 2015, 29(1): 112-121.
[19] Zochodne DW, Bolton CF, Wells GA, et al. Critical illness polyneuropathy. A complication of sepsis and multiple organ failure[J]. Brain, 1987, 110(Pt 4): 819-841.
[20] Hermans G, Van den Berghe G. Clinical review: intensive care unit acquired weakness[J]. Crit Care, 2015, 19: 274.
[21] 王洪亮, 章志丹, 黄伟. 拯救脓毒症运动:脓毒症与感染性休克治疗国际指南(2016)的解读与展望[J]. 中华重症医学电子杂志, 2017,3(1):26-32.
[22] 谢剑锋, 邱海波. 拯救脓毒症运动:脓毒症与感染性休克治疗国际指南(2016)的进展与评论[J]. 中华重症医学电子杂志, 2017,3(1):18-25.
[23] Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial[J]. Lancet, 2009, 373(9678): 1874-1882.
[24] Li H, Wu LM, Kong XB, et al. Reversible tetraplegia after percutaneous nephrostolithotomy and septic shock: a case of critical illness polyneuropathy and myopathy with acute onset and complete recovery[J]. BMC Nephrology, 2013, 14: 36.
[25] Saliba L, Cook CH, Dungan KM, et al. Medication-induced and spontaneous hypoglycemia carry the same risk for hospital mortality in critically ill patients[J]. J Crit Care, 2016, 36: 13-17.
[26] 王晨, 李俏俏. 重组生长激素对COPD合并呼吸衰竭患者应用呼吸机过程中的免疫保护作用[J]. 中国生化药物杂志, 2016,36(11):77-80.
[27] 王爱民, 刘伯毅, 方志成, 等. 老年患者胸腹部术后急性呼吸衰竭机械通气应用重组人生长激素的剂量探讨[J]. 临床肺科杂志, 2012,17(9):1589-1591.
[28] 应可, 陆红. 重组人生长激素治疗呼吸衰竭并脱机困难的临床观察[J]. 中国中医药咨讯, 2010,2(17):202.
[29] 柯卉, 黄海燕. 四级早期活动与康复锻炼疗法预防病人ICU获得性衰弱的效果观察[J]. 护理研究, 2016,30(6c):2202-2205.
[30] 何务晶, 黄玉莲, 李艳芳, 等. 分级康复训练对ICU机械通气患者肌力衰弱、压疮的影响[J]. 护理实践与研究, 2018,15(5):155-157.
[31] 张圣宇, 张兆波. 重症监护病房获得性肌无力的评估与早期康复干预[J]. 中国康复医学杂志, 2017,32(5):603-606.
[32] 吴娇华, 梁金清. 以呼吸肌功能锻炼为主的肺康复治疗在慢性肺部疾病中的应用研究进展[J]. 蛇志, 2014,26(1):97-99.
[33] 郭涛, 童华生. 心肺康复治疗在ICU获得性衰弱患者中的应用及效果观察[J]. 中国康复, 2017,32(5):383-385.
[34] 周兴强, 徐治波, 李汶静, 等. 早期肺康复训练对有创机械通气重症肺炎患者的影响[J]. 遵义医学院学报, 2016,39(5):503-507.